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 bestwork. Get the training you need to build the success you want. Classes starting soon, so apply today!
Whats your next move? How about right to the leading edge of health care - where youll find UnitedHealth Group setting the pace for quality, service and employee development. In fact, thats more than a move, its 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 lifes best work.
When you join our team as a Claims Adjustment Representative, youll 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.
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
UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.
We are committed to introducing innovative approaches, products and services that can improve personal health and promote healthier populations in local communities. Our core capabilities... in clinical care resources, information and technology uniquely enable us to meet the evolving needs of a changing health care environment as millions more Americans enter a structured system of health benefits and we help build a stronger, higher quality health system that is sustainable for the long term.
We serve our clients and consumers through two distinct platforms:
?UnitedHealthcare, which provides health care coverage and benefits services.
?Optum, which provides information and technology-enabled health services.