Remote Clinical Compliance Auditor – Program Integrity

Taleo; Boston (MA); Remote; USD 40,000 - 72,000; Full time

Job summary

UnitedHealth Group's Optum Insight unit seeks a Sr. Recovery Resolution Analyst to perform compliance reviews of medical and administrative documentation, identifying fraud and waste. Travel to provider sites up to 25% and conduct site visits to gather records.

This remote MA role is full-time and follows standard business hours with occasional overtime. You will work with audit workflow tools, present findings to clients, and support appeal and investigation activities while delivering

Qualifications

• High School Diploma / GED or equivalent work experience.
• Nurse licensure (RN or LPN) with a current, active license in Massachusetts.

Responsibilities

• Review medical and administrative records for audit/compliance review.
• Travel to provider sites up to 25%/month to collect records and engage with providers.
• Present and participate in discussions with the client regarding audit observations and findings.
• Collaborate with a team of 2-5 auditors to complete reviews.
• Enter audit findings data and notes in online/electronic platform using Excel-based templates.
• Attend and participate in dispute reviews and administrative hearings.
• Demonstrated written and verbal communications skills.
• Demonstrated customer service skills.

Skills

Written communication

Verbal communication

Customer service

Travel readiness

Education

Nurse licensure (RN or LPN) MA

High School Diploma / GED

Tools

MS Office Suite (Word, PowerPoint, Excel)

Job description

UnitedHealth Group's Optum Insight unit seeks a Sr. Recovery Resolution Analyst to perform compliance reviews of medical and administrative documentation, identifying fraud and waste. Travel to provider sites up to 25% and conduct site visits to gather records.

This remote MA role is full-time and follows standard business hours with occasional overtime. You will work with audit workflow tools, present findings to clients, and support appeal and investigation activities while delivering