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.
This is a challenging role that takes an ability to thoroughly review, analyze and research complex healthcare 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.
- Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims
- Analyze and identify trends and provide reports as necessary
- Consistently meet established productivity, schedule adherence and quality standards
- Attention to detail is critical to ensure accuracy which will support 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.
- High School Diploma / GED (or higher) or equivalent years of work experience
- 3 + years of experience in an healthcare or office environment using the telephone and computer as the primary instruments to perform job duties
- 3+ years of work experience working on a computer in Windows applications with the ability to learn new and complex computer systems in the medical field with a Customer Service background in Commercial appeals
- Available to work 40 hours per week within the operating hours of the site with overtime and weekends as needed.
- Prior health insurance industry or healthcare industry experience
- Prior experience in a production/quality based role
- Prior experience with medical claims processing
- Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product
- Ability to remain focused and productive each day though tasks may be repetitive
Physical Requirements and Work Environment:
- Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouse
- Office environment
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.