• Job Description

  Req#: 2174904

  Opportunities at WellMed , part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.

  This is an opportunity that’s all about where you’ve been. Your experience. Your potential. Your skills. Because on the team at UnitedHealth Group, your potential and your impact can be career changing. No company has put together better teams of passionate, energetic and all out brilliant Claims Representatives. This is where you come in. We’ll look for your experience and expertise to help keep our service levels and accuracy extremely high. We’ll also look for your ideas on how to constantly evolve our claims processes. We’ll back you with the great training, support and opportunities you’d expect from a Fortune 5 leader.

  You’ll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges.

  Primary Responsibilities:

  • Manually adjust pended escalated claims to resolve complex issues related to claim payments
  • Support implementation of updates to the current procedures and participate in new system updates and training
  • Review and apply member benefit plans and provider contracts, Pricing, CMS rate letter, SCA’s etc. to ensure proper benefits and contract language is applied to each claim
  • Analyze and identify trends and provides reports as necessary

  This is a challenging role that takes an ability to thoroughly review, analyze and research complex health care claims in order to identify discrepancies, verify pricing, confirm prior authorizations and process them for payment. You’ll need to be comfortable navigating across various computer systems to locate critical information. Attention to detail is critical to ensure accuracy which will ensure timely processing of the member's claim.

  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 or GED OR equivalent years of work experience
  • 3+ years of experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools
  • 3+ years of experience in metric-based environment (production, quality)
  • 1+ years of experience processing medical, dental, prescription or mental health claims
  • Proficiency with computer and Windows PC applications (Word, Excel etc.), which includes the ability to navigate and learn new and complex computer system applications

  
  Preferred Qualifications:

  • Associate’s Degree in a healthcare related field
  • Proven exceptional ability to organize, prioritize and communicate effectively

  California, Colorado, Connecticut, Nevada, New Jersey , New York , Rhode Island , or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island or Washington residents is $18.80 to $36.78 per hour . Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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

  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.
  
  
  
  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.

• About the company

  UnitedHealth Group Incorporated is an American multinational managed healthcare and insurance company based in Minnetonka, Minnesota.

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