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This is a quality role that supports the Optum Payment Integrity Fraud, Waste, Abuse and Error business units. This role is responsible for the determining the accuracy of the outcome of claim payment decisions after clinical review of medical record submissions.
Validate the accuracy of clinical medical record reviews and payment decisions.
Develop and deliver fact based audit determinations.
Serve on applicable cross-functional quality committees and work groups to identify and communicate common quality issues, trends, and patterns.
UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.
We are committed to introducing innovative approaches, products and services that can improve personal health and promote healthier populations in local communities. Our core capabilities... in clinical care resources, information and technology uniquely enable us to meet the evolving needs of a changing health care environment as millions more Americans enter a structured system of health benefits and we help build a stronger, higher quality health system that is sustainable for the long term.
We serve our clients and consumers through two distinct platforms:
?UnitedHealthcare, which provides health care coverage and benefits services.
?Optum, which provides information and technology-enabled health services.