Position Description:We'll put you in the driver's seat on vital projects that have strategic importance to our mission of helping people lead healthier lives. Yes, we share a mission that inspires. We need your organizational talents and business discipline to help fuel ours. It's the opportunity to do your life's best work.This Quality Assurance Specialist position is required to handle increased workload associated with Prior Authorization system setup. The Prior Authorization system setup includes the loading of letters, updating of tables, loading clinical guidelines, and updating automated decision trees. This role is vital since without it we will risk incomplete guidelines, incomplete or incorrect approval and denial letters loaded for each client for each migration resulting in increased cost to client and decreased member satisfaction. Positions in this function include those responsible for providing process and operational support to the functions within Business Operations Family. Positions in this function may also be responsible for quality reporting, analysis and audits, and for developing plans and programs to support continuous quality improvement using applicable tools. Employees in jobs labeled with SCA must support a government Service Contract Act (SCA) agreement.Primary Responsibilities: Assign and track DBP-CA Provider Site Reviews Process initial site review letters Assist in the coordination of audits and CADP shared audit Enter incoming audits / CAPs into Access database Sort/distribute mail; scan documents for archives and regulatory purposes Answer phone calls; make follow-up phone calls Assist in scheduling and coordination of meetings Generate letters and correspondence Works independently Acts as a resource for others
Required Qualifications: High School Diploma / GED (or higher) Previous Customer Service experience Previous experience working with Microsoft Word (ability to create, edit, mail merge) Previous experience working with Microsoft Excel (ability to work with tables, create formulas) Knowledge of Microsoft Access (ability to create forms and reports) Previous Data entry typing experience Preferred Requirements: Bachelor's Degree (or higher) Dental Insurance experience Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.Keywords: UnitedHealth Group; Senior Provider Service Representative; San Antonio, TX; Word; Excel; Managed Care; Medical Insurance
Internal Number: 751699
About UnitedHealth Group
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.