Remote Clinical Compliance Auditor – Health Claims

Mass Digital Health; Boston (MA); Remote; USD 40,000 - 72,000; Full time

Benefits offered by this job

Benefits package

Equity stock purchase

401k contribution

Job summary

UnitedHealth Group's Optum Insight is seeking a Sr. Recovery Resolution Analyst in Massachusetts to perform compliance reviews of medical and administrative documentation.

The role is remote within MA with 40 hours/week, Monday–Friday, 8:00 am–5:00 pm local time, and occasional overtime. Primary duties include reviewing records, traveling up to 25% within MA, presenting findings to clients, and using Excel-based templates.

Qualifications

• High School Diploma or GED or equivalent work experience.
• Nurse licensure (RN or LPN) with MA license and active status.
• 2+ years of experience reviewing health care documentation.
• Willingness to travel up to 25% within MA and valid drivers license.
• Proficient in Word, PowerPoint, and Excel with data-analysis basics.

Responsibilities

• Perform compliance reviews of medical/administrative documentation.
• Identify healthcare fraud, waste, or abuse from claims data and records.
• Conduct site visits and desk audits of provider records and claims.
• Present audit findings to client and input data into audit tools.
• Support appeal and fraud investigation activities when applicable.

Skills

MS Office Suite

Excel

Data analysis

Communication skills

Travel readiness

Education

High School Diploma or GED

Nurse licensure (RN or LPN) in MA

Tools

MS Office Word

MS Office PowerPoint

MS Office Excel

Job description

UnitedHealth Group's Optum Insight is seeking a Sr. Recovery Resolution Analyst in Massachusetts to perform compliance reviews of medical and administrative documentation.

The role is remote within MA with 40 hours/week, Monday–Friday, 8:00 am–5:00 pm local time, and occasional overtime. Primary duties include reviewing records, traveling up to 25% within MA, presenting findings to clients, and using Excel-based templates.