UnitedHealth Group is hiring

Claims Representative Associate - Work From Home job at UnitedHealth Group, San Diego

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If you are located within CST, MST or PST, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges.

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.SM

Imagine this. Everyday, in claims centers around the world, UnitedHealth Group is processing and resolving payment information for millions of transactions. Would you think we have some great technology? Would you think we know how to manage volume? You would be right. No one's better. And no company has put together better teams of passionate, energetic and all out brilliant Claims Representatives. This is where you come in. We'll look to you to maintain our reputation for service, accuracy and a positive claims experience. We'll back you with great training, support and opportunities.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities

  • Adjudication of claims to quality and production standards applicable to this position.
  • Monitor work inventory and submit non-I Max sheets completed accurately by first day of each month.
  • Analyze medical claims to ensure accurate claims adjudication.  Claims processing in accordance with EOC, Benefit Schedules and Provider Contracts.
  • Release by deadline to meet Company, state regulations, contractual agreements and group performance standards.
  • Problem identification and reporting to management.
  • Resolution of priority projects.
  • Performs all job functions with a high degree of discretion and confidentiality in compliance with federal, SHS and departmental confidentiality guidelines.

This is a challenging role that takes an ability to thoroughly review, analyze and research complex health care 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. Attention to detail is critical to ensure accuracy, which will impact the 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.

Required Qualifications:

  • High school diploma / GED (or higher) OR equivalent years of work experience
  • Proficiency with Windows PC applications, which includes the ability to navigate multiple programs and learn new and complex computer system applications
  • Medical terminology, ICD-10, CPT coding, Insurance Certificates, Benefit Schedules, Provider/Group Contracts and Standard Industry Practices.  Must posses understanding of basis mathematics.   
  • 6+ months work experience in Insurance Claims office, Medical office or Medical billing

Preferred Qualification:

  • Must demonstrate knowledge of or ability to learn and apply to job functions, those federal and state laws and regulations applicable to the operating unit. 
  • Intermediate computer skills and 10-key by touch. 
  • 1+ years medical claims processing experience in HMO/PPO or indemnity products.      

Soft skills:

  • Ability to work under pressure in high production environment. 
  • Ability to maintain balanced performance in areas of production and quality. 
  • Analytical reasoning and flexibility. 
  • Positive work ethic. 
  • Strong team player skills. 
  • Ability to make basic decisions.

Telecommuting Requirements:

  • Reside within CST, MST and PST
  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
  • Ability to keep all company sensitive documents secure (if applicable)
  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at https://uhg.hr/transitioning-military

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet

Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is 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.

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Job country: United States

City: San Diego

Category: Insurance Claims Clerks

Location: San Diego, CA, United States

Job posted 2022-06-04

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