Senior Claim Quality – Audit Representative

CPS Solutions; Dallas (TX); Remote; USD 80,000 - 100,000; Full time

Job summary

A leading healthcare company is seeking an experienced claims auditor for a national remote role. You will audit Medicare and Retirement claims, analyze trends, and support team performance. Candidates should have at least 2 years of relevant experience and possess strong organizational skills. The position offers flexible scheduling with full-time hours and a competitive hourly rate between $20.00 and $35.72, complemented by a comprehensive benefits package.

Benefits

Comprehensive benefits package

401k contribution

Incentive programs

Qualifications

• 2 years of experience in M&R Cosmos Medical Claims.
• Ability to work independently and manage time effectively.
• Proficiency with computer and Windows applications.

Responsibilities

• Review, research, and audit Medicare and Retirement claims.
• Analyze trends and provide feedback to reduce errors.
• Create and maintain reports related to performance.

Skills

Organizational skills

Proficiency in Microsoft Excel

Proficiency in Microsoft PowerPoint

Proficiency in Microsoft OneNote

Education

High School Diploma / GED or equivalent work experience

Job description

Overview

This position is National Remote. You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. This position is full-time (40 hours per week), Monday through Friday, with flexible scheduling options. Employees are required to work shifts ranging from 8 to 10 hours, and the role allows for several scheduling configurations: five 8-hour days, four 10-hour days, or a combination of four 9-hour days with one 4-hour day. The required start time falls between 5:00 AM and 8:00 AM CST. Depending on business needs, occasional overtime may be necessary. This flexible structure supports both operational efficiency and work-life balance. Training will be conducted virtually on the job, with hours tailored to the candidate’s availability and the training team’s schedule.

Primary Responsibilities

• Review, research, investigate, and audit Medicare and Retirement (M&R) Cosmos medical claims and provide feedback to team members on audit results
• Analyze and identify trends and provide feedback and reports to reduce errors and improve claims processes and performance
• Analyze information and utilize to build recommendations to reduce errors and improve process performance
• Create, maintain, and track reports in relation to performance
• Engage in team discussions / activity to resolve complex audit scenarios
• Effectively interact with business partners across the enterprise

Required Qualifications

• High School Diploma / GED OR equivalent work experience
• Must be 18 years of age OR older
• 2 years of experience in M&R Cosmos Medical Claims
• 2 years of experience in consistently utilizing Cosmos and CPW / CPA
• Proficiency with using computer and Windows personal computer applications, which includes the ability to navigate and learn new computer system applications
• Ability to work independently and manage time effectively with minimal supervision
• Ability to work shifts ranging from 8 to 10 hours, and the role allows for several scheduling configurations: five 8-hour days, four 10-hour days, or a combination of four 9-hour days with one 4-hour day. The required starting time falls between 5:00 AM and 8:00 AM CST.

Preferred Qualifications

• Experience in M&R Cosmos claim adjustments / rework
• Basic experience in Microsoft Excel (data entry, sorting, filtering)
• Basic experience in Microsoft PowerPoint (creating and editing presentations)
• Basic experience in Microsoft OneNote (creating notebooks and managing task list in a collaborative documentation)

Telecommuting Requirements

• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• 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

• Demonstrated organizational skills and the ability to effectively prioritize multiple tasks, priorities, projects, and deadlines

Compensation and Benefits

Pay is based on several factors including, but not limited to, local labor markets, education, work experience, certifications, etc. The hourly pay for this role will range from $20.00 – $35.72 per hour based on full-time employment. In addition to salary, we offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). This role includes a broad set of benefits and incentives.

Other

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. UnitedHealth Group is an Equal Employment Opportunity employer and a drug-free workplace. Candidates are required to pass a drug test before beginning employment. #RPO