09/21/2022

Senior Claims Business Process Analyst - Las Vegas, NV

  • UnitedHealth Group
  • Los Angeles, CA, United States

Job Description

If you are located in Las Vegas, NV, you will have the flexibility to work from home and the office in this hybrid role* as you take on some tough challenges.



Training is conducted virtually from your home. This role is an onsite role and once training is completed, you will transition to work in the office in the future.



Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life’s best work.SM



Flexible, Friendly, Fast on your feet, that's a great start. Accurate, Accountable, Self-Directed; These traits can take you places. Our claims operations are the focal point of handling information about services patients receive and they way those services get paid. It's complex, detailed work. It's fast paced challenge. It's a job that calls on you to be thoughtful, resourceful, team-driven and customer-focused. To put it mildly, there is never a dull moment. Senior Claims Business Process Analysts are responsible for all related aspects of claim system processes and claim business rules. Include claims systems utilization, capacity analyses/planning and reporting, claims-related business and systems analysis. Ensure data integrity, data security and process optimization.



This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of (7:30am - 4:00pm PST) It may be necessary, given the business need, to work occasional overtime.



Our office is located at 2720 N Tenaya Way Las Vegas NV 89120. Employees will be required to work some days onsite and some days from home



*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.



Primary Responsibilities:




  • Responsible for triaging, investigating and educating instances of healthcare fraud waste and or abuse by the medical profession or insured members.
  • Develop and deploy the most effective and efficient investigative strategy for each investigation
  • Review claims data and conduct analysis to look for patterns for potential fraud waste and/or abuse
  • Maintain accurate, current and thorough case information in the Fraud Database.
  • Collect and secure documentation or evidence and prepare summaries of the findings.
  • Conduct investigations to review claims history and compare medical documentation against procedural codes billed.
  • Ensure compliance of applicable federal/state regulations or contractual obligations
  • Report suspected fraud waste and abuse to appropriate federal or state government regulators


You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.


Required Qualifications:




  • Bachelor's Degree (or higher) OR High School Diploma / GED with equivalent experience
  • 3+ years in a technical or metrics-based environment; preferably claims and/or customer service 
  • Experience with Microsoft Excel (creating spreadsheets and formulas), Microsoft Word (creating documents) and Microsoft Outlook (drafting emails, calendar management)
  • Ability to work full time, Monday – Friday between 7:30am – 4:00pm PST
  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation


Preferred Qualifications:




  • 2+ years of experience in claims processing, healthcare provider information and/or healthcare billing practices.
  • 1+ years of experience with medical terminology
  • 1+ years of experience/training in healthcare FWA investigations
  • 1+ years of experience of claim coding
  • 1+ years of experience with local, state/federal laws and regulations pertaining to healthcare fraud, waste and abuse
  • National Healthcare Anti- Fraud association (NHCAA
  • Accredited Healthcare Fraud Investigator (AHFI)
  • Certified Fraud Examiner (CFE)
  • Certified Professional Coder (CPC)


Telecommuting Requirements:




  • Reside within Las Vegas, NV
  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
  • Ability to keep all company sensitive documents secure (if applicable)
  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service


Soft Skills:




  • Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product


UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.



Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at https://uhg.hr/transitioning-military



Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet



Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of healthcare. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life’s best work.SM



Nevada Residents Only: The salary range for Nevada residents is $23.94 - $42.40. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.



Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.



UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.



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