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Positions in this function are responsible for providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims. Authorizes the appropriate payment or refers claims to investigators for further review. Conducts data entry and re-work; analyzes and identifies trends and provides reports as necessary.
The Claims Clerk is responsible for providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims.
- 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.
- 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
- Will use numeric 10 key pad and Microsoft Excel
- High School Diploma / GED or higher
- 1+ year of experience in an Office setting environment using the telephone and computer as the primary instruments to perform job duties
- Basic proficiency with computer, Windows PC applications, and numeric 10 key, which includes the ability to learn new and complex computer system applications
- 2+ years Data Entry experience
- Basic understanding of Healthcare claims including ICD-9 and CPT codes
- 1+ years of experience working with Medical claims
- Ability to create, copy, edit, send, and save within Word, Excel, and Outlook
- 1+ year working in production based environment
- Type 60+ words per minute
Physical Requirements and Work Environment:
- Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouse
- Office environment
- Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product
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.
Keywords: Wausau, WI, Claims Clerk, data entry, medical claims, Word, Excel, Outlook, production,