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 Medical Claims Examiner. 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 6 leader.
To process the medical claims of AppleCare’s IPA clients pursuant to designated production quotas for accuracy and productivity benchmarks. Our production quotas are a minimum of 175 IPA claims per day.
**Please note that this is not a Billing position, but an actual Claims Examiner position.
- Batch and prioritize a minimum of 175 IPA claims processing per day utilizing the company’s in - house claims processing system
- Verify patient’s accounts for eligibility and benefits
- Process complex claims that have been accepted for payment
- Request and follow - up on additional information as needed for incomplete claims
- Complete all steps above within designated timeframes (production quotas) and notify management if claims cannot be processed within the designated time frame
- Assemble denial letter background information and generate denial letters
- Read, interpret and summarize medical contracts/division of responsibility before allowance of payments
- Identify claims that are not our financial risk and forward to appropriate entity for payment
- Review claims that are pending and follows through for payment in a timely manner
- Works with various fee schedules (i.e., CMS, Medical)
- Treat peers, superiors, subordinates clients and vendors with fairness, courtesy and professionalism and contribute to the overall positive work environment of the department
- Complete other production projects as assigned
- High school graduate
- Requires 2+ years experience working as an actual “Claims Examiner” in a Managed Care environment (Not as a Billing Clerk working on claims).
- 2+ years of experience working with various fee schedules (i.e., CMS, Medical, etc.)
- Strong proficiency with computer and Windows PC applications, which includes the ability to learn new computer system applications
AppleCare Medical Management Group was incorporated in 2003. Over the last 17 years, the multispecialty medical group of independent practices has expanded into new
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.