Claims Compliance Support Assistant

Requisition number: 2356954

Job category: Claims

This position follows a hybrid schedule with three (3) in-office days per week . Our office is located at 19191 South Vermont Ave. Torrance, CA Suite 700.

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Claims Compliance Support Assistant is responsible for providing administrative support to the Compliance Department, with a primary focus on preparing and mailing Member and Provider notification letters. This role ensures that all correspondence is accurate, timely, and compliant with regulatory requirements and internal policies. Additionally, the assistant supports the preparation of health plan audits and assists with other compliance-related tasks and inquiries.

This position is full time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00 am - 5:00 pm PST. It may be necessary, given the business need, to work occasional overtime.

This will be on the job training and the hours during training will be aligned to your schedule.

Primary Responsibilities:

• Monitor and manage printing queues for Member and Provider Notices related to claims.

• Verify and ensure appropriate language and regulatory citations are included, based on line of business (Medicare, Medicaid, Commercial).

• Accurately maintain tracking logs and reporting mechanisms for audit and compliance purposes.

• Ensure timely mailing of notices in accordance with guidelines from the Department of Managed Health Care (DMHC), Centers for Medicare & Medicaid Services (CMS), and other regulatory bodies.

• Coordinate with Compliance staff to ensure all required documentation is included with Member and Provider correspondence.

• Organize and maintain a mailing system for member and provider notices and all supporting documentation.

• Assist with the preparation and assembly of audit packets, including Paid, Denied, Provider Dispute Resolution (PDR), Adjustment, and Contested claims

• Maintain confidentiality of member information in accordance with HIPAA Regulations.

• Perform additional administrative duties in support of the Compliance and Delegation Oversight team as needed.

• Other duties as assigned

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School Diploma / GED OR equivalent work experience

• Must be 18 years of age OR older

• 1+ years of healthcare OR administrative experience, preferably in claims, compliance, OR days managed care environment.

• Experience with computers and Windows based programs including proficiency in Microsoft Office (Word, Excel, Outlook).

• Attention to detail and organizational skills.

• Ability to work on-site Monday - Friday, during normal business hours of 7:00am - 5:00pm PST, including the flexibility to work occasional overtime and weekends, based on business need.

Preferred Qualifications:

• Familiarity with regulatory guidelines (DMHC, CMS) a plus.

• Knowledge of medical terminology and healthcare claims processing

Telecommuting Requirements:

• Reside within commutable distance to the office at 19191 South Vermont Ave. Torrance, CA Suite 700.

• 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:

• Ability to manage multiple priorities and meet strict deadlines.

• Excellent written and verbal communication skills.

• Ability to work independently and as part of a team.

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $16.00 - $25.05 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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 is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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