Claims Adjustment Representative - US Telecommute

UnitedHealth Group
Aug 12, 2017
Aug 14, 2017
Employer Type
Direct Employer
Employment Type
Full Time
Position Description:

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.

Get the training you need to build the success you want. Classes starting soon, so apply today!

What's your next move? How about right to the leading edge of health care - where you'll find UnitedHealth Group setting the pace for quality, service and employee development. In fact, that's more than a move, it's a leap. Join one of our high performing teams and you can play a critical role in creating a quality experience for our members and providers. Take your current claims knowledge add our outstanding training program and support and see how your knowledge, job satisfaction and career will grow. If you have a high degree of personal accountability, attention to detail and a love of problem-solving, we can provide the challenge you need and the career opportunities you want. This could be your opportunity to expand your career as you do your life's best work.

When you join our team as a Claims Adjustment Representative, you'll be responsible for reviewing and making adjustments or corrections to processed claims through researching, investigating issues, making a determination and then communicating as required. You will authorize the appropriate adjustment or sometimes refer the claims to other team members for further review. Conducting data entry and re-work; analyzing and identifying trends as well as providing reports as necessary, this will also be a part of your daily routine.

This position is full-time (40 hours / week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 AM-4:30 PM, CST. This is a telecommute / work at home role.

Primary Responsibilities:

* Review and research claims by navigating multiple computer systems and platforms and accurately capturing the data / information necessary for processing (e.g. verify pricing, prior authorizations, applicable benefits, coding)
* Update claim information based on research and communication from members or providers
* Complete necessary adjustments to claims and ensures the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS / Medicare guidelines, benefit plan documents / certificates)
* Communicates extensively with members and providers regarding adjustments to resolve claims errors / issues, using clear, simple language to ensure understanding
* Learn and leverages new systems and training resources to help apply claims processes / procedures appropriately (e.g. on-line training classes, coaches / mentors)
* Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction and attendance

Required Qualifications:

* High School Diploma / GED
* 1+ years of experience in a related environment (i.e. office, administrative, clerical, customer service, etc.)
* 1+ years of experience working with medical claims
* Experience using Microsoft Word (create and edit documents), Microsoft Excel (data entry, filtering and sorting), and Microsoft Outlook (send and receive emails)
* Experience composing and sending out written correspondence free of grammatical errors
* Ability to meet work schedule Monday-Friday 8:00 am - 4:30 pm, CST, including during the required training period. Overtime may be required as business needs arise
* Required to have a work area in a section of the residence that provides information privacy
* Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Preferred Qualifications:

* Experience with CSP Facets
* Experience adjusting claims
* Experience working with CareOne and ICUE

Soft Skills:

* Ability to multi-task, including the 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:

* Required to have a dedicated work area established that is separated from other living areas
* Required to keep all Company's sensitive documents secure
* Required to have lockable drawers for the securing of confidential information

There are several steps in our hiring process - it's a thorough process because we want to ensure the best job and culture fit for you and for us. In today's ultra-competitive job market, the importance of putting your best foot forward is more important than ever. And you can start by completing all required sections of your application. (i.e. profile, history, certifications and application/job questions). Once you submit your resume, you'll receive an email with next steps. This may include a link for an on-line pre-screening test that we ask you to complete as part of our selection process. You may also be asked to complete a digital video interview, but we will offer full instructions and tips to help you. After you have completed all of these steps, you can check on the status of your application at any time, but you will also be notified via e-mail.

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in healthcare here. We serve the healthcare needs of low income adults and children with debilitating illnesses such as Cardiovascular Disease, Diabetes, HIV/AIDS and High-risk Pregnancy. Our holistic, outcomes-based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive Healthcare, Community, and Government partners to heal healthcare and create positive change for those who need it most. This is the place to do your life's best work.

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: claims, medical claims, healthcare claims, claims processing, claims processor; office, UnitedHealth Group, UnitedHealthcare, training class, customer service representative, customer service, CSR, Data Entry, appeals, dispute resolution, phone support

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