Clinical Claims Auditor (RN/Coder)

Optum; San Juan (PR); On-site; USD 60,000 - 76,000; Full time

Job summary

UnitedHealth Group in San Juan, Puerto Rico, is seeking a skilled Clinical Auditor to review professional and facility claims, compare with medical records, and determine claim viability for further processing. The role emphasizes data accuracy, compliance, and clear clinical reasoning for providers.

The position requires a Coding Certificate or Nursing Licensure, proficiency with Microsoft Office, and fluency in English and Spanish.

Qualifications

• Coding Certificate or Nursing Licensure is required.
• Proficiency with computers including the Microsoft Office suite.
• Professional proficiency in both English and Spanish (an English proficiency assessment may be required).

Responsibilities

• Perform clinical review of professional or facility claims against medical records.
• Maintain productivity and accuracy standards as defined by the department.
• Provide clear clinical logic to providers and ensure data integrity and compliance.

Skills

Coding Certificate

Nursing Licensure

MS Office

English/Spanish

On-site work model

Tools

Microsoft Office

Job description

UnitedHealth Group in San Juan, Puerto Rico, is seeking a skilled Clinical Auditor to review professional and facility claims, compare with medical records, and determine claim viability for further processing. The role emphasizes data accuracy, compliance, and clear clinical reasoning for providers.

The position requires a Coding Certificate or Nursing Licensure, proficiency with Microsoft Office, and fluency in English and Spanish.