Job Description

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing togetherPrimary Responsibilities:

• This hiring is for OTC - Over the Counter Process from Optum Financial - Under Optum Financial, the Directed Spend business offers several supplemental benefits or xe2x80x9capproved product listsxe2x80x9d (APLs) that we maintain which influence how transactions and items are approved and denied in real-time at retailer's checkout. These APLs (think OTC, Healthy Food or a combination of both) are configured based on the client needs. The related work here is largely around ensuring product SKUs are categorizing to each APL
• Primarily maintain and/or enable Approved Product List (APL) across retailers working with cross-functional teams
• Support data analysis to monitor and innovate relevant metrics on the platform and subsequently help bridge identified gaps with the Team
• Provide expertise and support by reviewing, researching, investigating and auditing member claims
• Analyze and identify trends and provide feedback and reports to reduce errors and improve claims processes and performance
• Adhere to the Audit Goals for a high/consistent performance delivery
• All aspects of quality assurance
• Accurate and timely documentation of data
• Routinely analyze quality results to report error trends
• Work with department Reporting Team to create measurement tools and methods for communicating results and managing QA analysis in compiling/reporting results
• Audit all claims in accordance with performance standards and corporate rules
• Perform audits on Phase 1 & 2 FTE product & data validation through various platforms, report errors for correction & avoid member impact
• Investigate discrepancies and review claim documentation
• Analyze and evaluate claim data to identify potential issues or areas of concern
• Assist in the development of strategies to reduce over and under payments
• Maintain accurate records of all audit activities - Dollar Accuracy and Overall accuracy
• Provide guidance and advice associates on audit outcome
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

EligibilityTo apply to an internal job, employees must meet the following criteria:

• Grade 23 move to 24, Grade 24 will move laterally
• Minimum of 12 months in the organization in current role
• Minimum duration of 12 months of continuous service in their current grade and position
• ME - 3 or above in the recent Common Review
• Not on Active PIP / CAP (Performance Improvement Plan) / Corrective Action at the time of applying for the IJP
• Immediate manager should be notified regarding the IJP as per current policy in place

Required Qualifications:

• Microsoft Excel Intermediate knowledge
• Auditor Skills:

• Analytical Thinking
• Attention to Detail
• Computer Literacy
• Share inputs to mistake proof
• Solid problem-solving abilities
• Willing to work in Night shifts and from Office Only considering PHI Guidelines - 100% RTO

Preferred Qualification:

• Over The Counter Process flow experience

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone - of every race, gender, sexuality, age, location and income - deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group