The Claims Representative Associateis responsible for providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Primary Responsibilities:
- Provide general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims.
- Authorize the appropriate payment or refers claims to investigators for further review.
- Conduct data entry and re-work; analyzes and identifies trends and provides reports as necessary.
- Analyze and identify trends and provide reports as necessary
- Consistently meet established productivity, schedule adherence, and quality standards
- Recognize claims by determining claim type – HCFA, Hospital, UB, and/or RX
- Identify more complicated claims and refer them to Senior Claim Processor or Supervisor
- Calculate other insurance and re-pricing benefits
- Work claims files to ensure the appropriate eligibility and provider records are matched to the claim
- Updates and maintains claims tracking database
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)
- 1+ years of experience in an office setting environment using the telephone and computer as the primary instruments to perform job duties
- Basic proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
- 2+ years of data entry experience
- Basic understanding of healthcare claims including ICD-9 and CPT codes
Telecommuting Requirements:
- 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
Preferred Qualifications:
- 1+ years of experience working with medical claims
- Prior experience working with IDX software
- 1+ years of working in production based environment
- Type 60+ WPM
Soft Skills:
- Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product