Energize your career with one of Healthcare’s fastest growing companies.
You dream of a great career with a great company – where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.
This opportunity is with one of our most exciting business areas: Optum – a growing part of our family of companies that make UnitedHealth Group a Fortune 5 leader.
Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.
Responsible for accurately and efficiently processing manual claims submitted by members, pharmacies and other organizations. Other duties include answering claims questions from internal departments, clients or members; handling escalated issues or troubleshooting claims; outreach to obtain missing information or clarification on submitted claims paperwork.Primary Responsibilities:
- Process manual claims, consistently meeting productivity and quality standards.
- Verify eligibility of member and status of accounts.
- Enter appropriate claims into claims platform, confirm accuracy of result and make appropriate changes if necessary
- Keep management informed of actual or potential system or procedural problems, plan set - up questions and need for system corrections to accurately process claims.
- Correctly process returns for any claims that cannot be entered into the system.
- Work with management to address escalated issues or claims with problems.
- Adhere to all individual employee performance standards including but not limited to productivity, quality and attendance.
- Other duties and projects as assigned
- Adhere to all company and departmental policies and procedures
- High School Diploma / GED (or higher)
- 1+ years of experience in either a healthcare or pharmacy environment
- 1+ years of work experience working on a computer in Windows applications with the ability to learn other complex computer systems
- Available to work from 7:00 am - 4:00 pm Monday through Friday with overtime, weekends and holidays as needed
- 1+ years of pharmacy or medical claims processing experience and / or customer service experience
- RxCLAIM experience
- Experience planning and prioritizing job tasks within deadlines
- Work efficiently and accurately meeting timeline expectations
- Strong attention to detail
- Interact with others in a positive, professional manner
Physical Requirements and Work Environment:
- Extended periods of sitting at a computer and use of hands / fingers across keyboard or mouse
- Office environment
OptumRx is an empowering place for people with the flexibility to help create change. Innovation is part of the job description. And passion for improving the lives of our customers is a motivating factor in everything we do.
If you're ready to talk about groundbreaking interactions, let's talk about what happens when a firm that touches millions of lives decides to gather results from millions of prescriptions every month and analyze their impact. Let's talk about smart, motivated teams. Let's talk about more effective and affordable healthcare solutions. This is caring. This is great chemistry. This is the way to make a difference. We're doing all this, and more, through a greater dedication to our shared values of integrity, compassion, relationships, innovation and performance. Join us and start doing your life’s best work.SM
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.
Keywords: United Health Group, United Health Care, Claims, Processing, Customer Service, Analyst, Audit, Pharmacy