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Remote Optum Prior Authorization Jobs in Minnesota

UnitedHealth Group

Senior Quality Engineer

Minnetonka, MN · Remote

$90K - $122K/yr

We are comprised of two distinct and complementary businesses, UnitedHealthcare and Optum , working ... Experience with healthcare datasets (claims, eligibility, prior authorization, provider directories)

Guardian Pharmacy

Collection's Specialist

Minneapolis, MN · Remote

$24 - $26/hr

Remote options available after 30-days of training on-site Starting Pay Range: $24-$26 Schedule ... This includes using pharmacy systems to process prior authorizations, resolve rejections, produce ...

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Remote Optum Prior Authorization information

What is a Remote Optum Prior Authorization?

A Remote Optum Prior Authorization job involves reviewing and processing requests from healthcare providers to determine whether certain medical procedures, medications, or services will be covered under a patient's insurance plan. Employees in this role work from home and use clinical guidelines to assess the necessity and appropriateness of requested treatments. They collaborate with providers, patients, and insurance teams to ensure timely authorization decisions. This position typically requires strong communication skills, attention to detail, and familiarity with healthcare regulations and insurance policies.

How does a Remote Optum Prior Authorization specialist typically interact with healthcare providers and insurance teams?

As a Remote Optum Prior Authorization specialist, you will regularly communicate with healthcare providers, pharmacies, and insurance representatives to obtain and verify necessary information for authorizing medical procedures or medications. Most interactions occur via phone, secure messaging, or electronic health record systems, requiring clear communication and attention to detail. Collaboration is essential, as you'll often need to clarify clinical documentation with providers and ensure compliance with insurance guidelines. This role is well-suited for those who are organized, proactive, and comfortable working independently within a supportive virtual team environment.

What are the key skills and qualifications needed to thrive as a Remote Optum Prior Authorization specialist, and why are they important?

To thrive as a Remote Optum Prior Authorization Specialist, you need strong knowledge of medical terminology, insurance processes, and prior authorization protocols, typically supported by a healthcare-related degree or relevant experience. Familiarity with electronic health record (EHR) systems, insurance verification tools, and prior authorization software is essential. Excellent attention to detail, organizational skills, and effective communication are vital soft skills for efficiently managing high volumes of authorization requests and collaborating with providers. These skills ensure accurate, timely approvals and help optimize patient care while reducing administrative delays.

What is the difference between Remote Optum Prior Authorization vs Remote Optum Claims Reviewer?

AspectRemote Optum Prior AuthorizationRemote Optum Claims Reviewer
CredentialsTypically requires healthcare-related certifications, such as RN, LPN, or medical coding credentialsOften requires similar healthcare certifications, with focus on claims processing
Work EnvironmentRemote, healthcare insurance setting, interacting with providers and patientsRemote, insurance claims processing environment, reviewing submitted claims
Employer & Industry UsageCommonly employed by health insurance companies like Optum, focusing on authorization processesEmployed by insurance companies, focusing on claims review and reimbursement

Remote Optum Prior Authorization specialists focus on obtaining approvals for healthcare services, while Remote Optum Claims Reviewers evaluate submitted claims for accuracy and reimbursement. Both roles require healthcare knowledge and certifications, but differ in their primary functions within the insurance process.

What are popular job titles related to Remote Optum Prior Authorization jobs in Minnesota?

For Remote Optum Prior Authorization jobs in Minnesota, the most frequently searched job titles are:

What job categories do people searching Remote Optum Prior Authorization jobs in Minnesota look for?

The top searched job categories for Remote Optum Prior Authorization jobs in Minnesota are:

What cities in Minnesota are hiring for Remote Optum Prior Authorization jobs?

Cities in Minnesota with the most Remote Optum Prior Authorization job openings:

Remote Optum Prior Authorization jobs near you

Senior Quality Engineer

UnitedHealth Group

Minnetonka, MN • Remote

$90K - $122K/yr

Full-time

Retirement

Re-posted 6 days ago

UnitedHealth Group rating

7.6

Company rating: 7.6 out of 10

Based on 146 frontline employees who took The Breakroom Quiz

190th of 888 rated healthcare providers

Job description

UnitedHealth Group is a health care and well-being company that's dedicated to improving the health outcomes of millions around the world. We are comprised of two distinct and complementary businesses, UnitedHealthcare and Optum, working to build a better health system for all. Here, your contributions matter as they will help transform health care for years to come. Make an impact with a team that shares your passion for helping others. Join us to start Caring. Connecting. Growing together.

In this role, you will design and implement robust, AI-powered testing solutions, utilizing cutting-edge tools like Playwright and TypeScript, to ensure the quality, scalability, and seamless integration of these transformational systems. Your work will directly impact millions of members by bringing accuracy, speed, and intelligence to our claims processing capabilities. 

Job Responsibilities 

  • Quality engineering leadership: Lead the QE strategy and drive end-to-end test automation across web, API, mobile, cloud, and AI-powered applications. 
  • Automation framework development: Design, build, and maintain scalable automation frameworks using Playwright, Selenium, Cypress, and modern testing tools. 
  • API and microservices validation: Build robust testing solutions using Rest Assured, Postman, contract testing, and service virtualization techniques. 
  • Engineering standards: Establish automation best practices, coding standards, quality gates, and CI/CD testing integrations. 
  • AI/GenAI validation: Develop validation frameworks for LLM response quality, accuracy, consistency, reliability, and responsible AI guardrails. 
  • Data integrity: Perform backend and database validation to ensure accuracy and consistency across distributed systems. 
  • Cross-functional collaboration: Partner with Product, Architecture, Engineering, and DevOps teams to define quality strategy and release readiness criteria. 
  • Shift-left quality: Drive adoption of shift-left testing, continuous testing, and automated regression practices across Agile teams. 
  • Technical mentorship: Mentor QE engineers, conduct code reviews, and provide technical leadership on quality engineering initiatives. 
  • Quality metrics: Measure and improve automation coverage, regression efficiency, release quality, and overall engineering productivity. 
  • Design, develop, and deploy AI-powered solutions to address complex business challenges with emphasis on responsible use of AI

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

Required Qualifications 

  • Bachelor's degree in Computer Science, Information Technology, Engineering, or related field
  • 8 years of experience in Quality Engineering, Test Automation, or Software Development Engineering in Test (SDET)
  • 5 years in Proven experience leading enterprise-scale automation programs and quality engineering initiatives 
  • 5 years in strong hands-on expertise in automation framework design, API testing, CI/CD integration, and modern quality engineering practices
  • 5 years in Experience working with large-scale enterprise applications in domains such as Healthcare, Financial Services, Insurance, Banking, or Technology

Preferred Skills 

  • AI/GenAI Testing and Validation, LLM Evaluation and Prompt Testing  
  • MCP-based Agent Testing, ChatGPT, GitHub Copilot, Gemini, Claude, Cursor AI  
  • Appium Mobile Automation, AWS, Azure, or GCP Cloud Testing  
  • Performance Testing using JMeter or LoadRunner  
  • Dynatrace, SonarQube, Browser Stack, Sauce Labs  
  • Event-Driven Architecture and Distributed Systems Testing  
  • Cloud Migration Validation and Data Reconciliation Testing 
  • Excellent communication, stakeholder management, and technical leadership skills.
  • Experience with healthcare datasets (claims, eligibility, prior authorization, provider directories)  
  • Understanding of clinical or operational workflows (provider calls, documentation, adjudication steps)  
  • Awareness of healthcare data sensitivity and HIPAAlike compliance expectations 

*All Telecommuters 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 $91,700 to $163,700 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. 

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. 

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.

#RPO #GREEN

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