Working in Operations at UnitedHealth Group is 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
Position in this function are responsible for the installation of assigned accounts, including, but not limited to: structure building and billing set up, structure revisions, researching & resolving structure issues, database loading, and preparation of plan materials such as administrative documents and customer education materials. Positions are responsible for overall employer contract loading using various databases and / or source documents. May research installation issues & develop customer specific resolutions. May include auditing contract loads for adherence to quality measures and reporting standards.
- Auditing contract loads for adherence to quality measures and reporting standards
- Researching errors by comparing Account Management documentation against multiple internal systems
- Analytical and Researching techniques to trend or quantify projects
- Preparing, processing, and maintaining new group installation and renewals
- Responding to member eligibility or group questions and verify enrollment status
- Reconciling reports and group set up discrepancies, as well as analyzing transactional data and submitting retroactive eligibility changes
- Research and respond to all claims processing inquiries from Client Management, Clinical, and other internal departments.
- Perform claim testing to ensure accurate claim adjudication
- Conduct installation of assigned accounts, including, but not limited to: structure building and billing set up, structure revisions, researching and resolving structure issues, database loading, and preparation of plan materials such as administrative documents and customer education material
- Overall employer contract loading using various databases and / or source documents. May research installation issues & develop customer specific resolutions which may include auditing contract loads for adherence to quality measures and reporting standards
- Perform other duties as assigned
- Basic structured, standard approach to work.
- High School Diploma / GED or higher
- 1+ years of experience in a healthcare insurance environment using the telephone and computer as the primary instruments to perform job duties
- Experience creating documents and navigating in Microsoft Word
- Experience with filtering, sorting and analyzing data in Microsoft Excel
- Monday - Friday 6am - 4:30pm. Should be able to work a shift between the dept. operation hours. Associate will be able to create their own shift within op hours as long as a SME is available. 1 -2 days / week to Telecommute is an option based on performance, quality and overall production after 3 months. Expectation is to be on - site every day
- CPhT certification (Certified Pharmacy Technician)
- Retail pharmacy experience
- Experience with pivot tables, VLOOKUP and formulas in Microsoft Excel
- Experience with AS400
- Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, and long periods working at a computer
- Service center environment with moderate noise level due to Representatives talking, computers, printers and floor activity
OptumRx is an empowering place for people with the flexibility to help create change. Innovation is part of the job description. And passion for improving the lives of our customers is a motivating factor in everything we do.
If you're ready to talk about groundbreaking interactions, let's talk about what happens when a firm that touches millions of lives decides to gather results from millions of prescriptions every month and analyze their impact. Let's talk about smart, motivated teams. Let's talk about more effective and affordable healthcare solutions. This is caring. This is great chemistry. This is the way to make a difference. We're doing all this, and more, through a greater dedication to our shared values of integrity, compassion, relationships, innovation and performance. Join us and start doing your life’s best work.SM
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
Keywords: UHG, Healthcare