Claims Representative Associate

Employer: UnitedHealth Group

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

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:

Soft Skills:

Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product