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Production Claims Auditor - Franklin, TN

Position Description
Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.SM

Primary Responsibilities:

  • Audit members and paid claims data
  • Investigate and resolve errant payments on all claims types, as well as assist in resolution for health plans, commercial customers, and government entities as needed
  • Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization
  • Initiate phone calls to providers, employer groups, and other insurance companies to gather pertinent claim information e.g., verification of member policies, confirmation of services received, and coordination of benefits information
  • Work directly with other departments to enhance and refine assigned inventory to maximize value
  • Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
  • Use pertinent data and facts to identify and solve a range of problems within area of expertise
  • Generally, work is self - directed and not prescribed
  • Works with less structured, more complex issues
  • Serves as a resource to others


  • Bachelor's Degree or higher
  • 1+ years of experience analyzing data and identifying cost saving opportunities (auditing and analyzing claims data) OR relevant college courses including economics, statistics, data science, finance, math, philosophy or music
  • Basic proficiency in math and thinking analytically and strategically
  • Intermediate level proficiency with Microsoft Excel (Sort, filtering, summing, formulas, formatting)
  • Knowledge and understanding of basic customer service skills including phone and email etiquette
  • Ability to work 40 hours weekly and overtime as business needs dictate


  • Working towards an advanced degree (statistics, economics, math, philosophy, music)
  • 2+ years of experience researching or auditing healthcare claims information
  • Computer proficiency in Microsoft Office including Word (create documents), Excel (data entry) and Outlook (send email / calendar utilization)
  • Experience in healthcare
  • Experience with medical claims (C & D and / or COB)

Soft Skills:

  • Must demonstrate exemplary verbal and written communication skills

Physical Requirements and Work Environment:

  • Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods working at a computer
  • Service center environment with moderate noise level due to Representatives talking, computers, printers, and floor activity

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work. SM

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: quality, auditing, reimbursement, data analysis, advanced analysis, formulas, data capture, charts, graphs, presentations, Excel

Production Claims Auditor - Franklin, TN

Franklin, TN
Full Time

Published on 03/09/2019