Claim representative

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best.

Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities.

Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring.

Connecting. Growing together.

Job Function 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.

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 5 : 00 pm.

It may be necessary, given the business need, to work occasional overtime.

We offer 2-3 weeks of paid training. The hours during training will be 8 : 00 am to 5 : 00 pm, Monday - Friday.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities

• Applies knowledge / skills to activities that often vary from day to day.
• Demonstrates a moderate level of knowledge and skills in own function.
• Requires little assistance with standard and non-standard requests.
• Solves routine problems on own.
• Works with supervisor to solve more complex problems.
• Prioritizes and organizes own work to meet agreed upon deadlines.
• Works with others as part of a team.
• Claims Processing Systems / Resources
• Use appropriate systems / platforms / applications to process claims .
• Navigate systems tools and screens efficiently and effectively (e.g., keyboard skills, macros, shortcuts)
• Use appropriate documentation, reference materials and / or websites to ensure that claims are processed accurately and efficiently.

e.g., policy / procedure manuals, knowledge libraries, bulletins, training materials, databases, SharePoint sites, data warehouses)

• Learn and use new systems / applications / resources as needed.
• Claims Processes and procedures :

oApply appropriate processes and procedures to process claims (e.g., claims processing policies and procedures, grievance procedures, state mandates, CMS / Medicare guidelines, benefit plan documents / certificates)

oLeverage training resources to help apply claims processes / procedures appropriately (e.g., UI-earn courses, coaches / mentors)

oApply knowledge of applicable laws, regulations and compliance requirements to ensure that claims are processed properly (e.

g., HIPAA, PPACA / Health Care Reform, state-specific regulations / grievance procedures, TAT

Demonstrate Knowledge Of Products and Services

oDemonstrate knowledge of applicable product / service offerings, and the value they provide to members and providers.

oKeep current on new product / service offerings and the value they provide.

oDemonstrate knowledge of benefit plan provisions (e.g., plan language, coverages, limitations, exclusions) and keep current on changes as they occur.

oApply knowledge of products and services to process claims appropriately

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.

Required Qualifications :

• High School diploma / GED (or higher) OR equivalent years of work experience
• Must be 18 years or older
• Microsoft Office Suite experience (Microsoft Outlook, Microsoft Excel, Microsoft Word)
• Ability to work any of our 8-hour shift schedules during our normal business hours of 8 : 00 am 5 : 00 pm. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications :

Experience processing medical, dental, prescription or mental health claims

Telecommuting Requirements :

• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and 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.
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington, Rhode Island, OR Washington, D.C. Residents Only : The hourly range for this is $16.

00 - $28.27 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc.

UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and k contribution (all benefits are subject to eligibility requirements).

No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

Application Deadline : This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected.

Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone.

We believe everyone of every race, gender, sexuality, age, location, and income deserves the opportunity to live their healthiest life.

Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes.

We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes an enterprise priority reflected in our mission.

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.

Last updated : 2024-10-31

Salary : $16 - $28