Claims Representative
UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.
Position Description:
Positions in this function are responsible for providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims. Authorizes the appropriate payment or refers claims to investigators for further review. Conducts data entry and re-work; analyzes and identifies trends and provides reports as necessary.
Primary Responsibilities:
- Provide claims pricing production for the U.R.N. Claims Operations.
- Maintain quality system standards of 15 claims per hours for pricing with 98% accuracy.
- Review all data elements on medical and hospital claims and prices the claim based on the applicable provider contract.
- Maintain knowledge of Facility Contracts assigned for claims review. (New, Existing, and Amendments)
- Review all warning messages that edit during adjudication and prices based on the directive in the message.
- Price all clean claims within 10 business days of receipt date.
- Maintain an accuracy rate of equal to or greater than 98%.
- Adhere to all documented pricing procedures.
- Provide back-up training expertise when required to support operational claims functions.
- Acknowledge and escalate claims pricing issues proactively.
Requirements:
- High School diploma/GED OR 10+ years of work experience required
- 1+ year of customer service experience analyzing and solving customer problems in an office setting environment using the telephone and computer as the primary instruments to perform job duties
- Familiarity with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
- Ability to navigate a computer while on the phone
- Experience in Microsoft Excel and Word
- FACETS Experience helpful
OptumHealth is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
If you want more meaning in your career - as a clinician or a business professional - think of OptumHealth as your calling.
By providing 58 million Americans with information, tools and solutions, we are helping to guide them through the health care system, financing their health care needs, and enabling them to achieve their personal health and well-being goals.
At OptumHealth, you will perform within an innovative culture that's focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact that's greater than you've ever imagined.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.