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We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM


Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com


Job Category:

Medical and Clinical Operations



Approximate Salary:

Not Specified

Position Type:

Full Time

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Claims Resolutions Specialist (LHI) - La Crosse, WI

UHG - La Crosse, Wisconsin

Posted: 11/12/2018

At Optum, the mission is clear:  Help people live healthier lives and help make the health system work better for everyone


LHI is one of 4 businesses under OptumServe. OptumServe provides health care services and proven expertise to help federal government agencies modernize the U.S. health system and improve the health and well - being of Americans.

By joining OptumServe you are part of the family of companies that make UnitedHealth Group a leader across most major segments in the U.S. health care system.


LHI was founded in 1999 and acquired by Optum in 2011, LHI specializes in creating and managing health care programs through on - location services, patient-specific in - clinic appointments, tele - health assessments, or any combination based on customer need.

LHI's customizable solutions serve the diverse needs of commercial customers, as well as federal and state agencies, including the U.S. Departments of Defense, Veterans Affairs, and Health and Human Services.


There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Ready for a new path? Start doing your life's best work.(sm)

Primary Responsibilities:

  • Maintain an ongoing responsibility for assigned claims inquiries which entails assessment, education and coordination for members / health care providers throughout the United States via telephone while keeping a detailed record within the internal database. Establish and maintain positive relationships with members, providers and our claims contractors.
  • Manage inbound and outbound calls from providers and members to resolve claims issues.
  • Request and manage medical records to help determine potential program coverage and communicate results to the members.
  • Completion of system generated tasks, including documenting all results as required.
  • Prepare comprehensive reviews and summaries for claims appeals.
  • Point of contact for internal departments to answer questions relative to member claims.
  • Work with the leadership team to resolve issues as needed.
  • Able to handle emotionally charged phone calls and ability to deliver unfavorable claims outcomes.
  • Ability to communicate complex program criteria into easily understood summaries in both oral & written communication.
  • Validation of claim coverage in relation to program guidelines.
  • Compete activities and reporting as required by the fraud, waste and abuse plan.

Required Qualifications:
  • High School Diploma / GED or higher or equivalent work experience
  • Medical claims processing experience or equivalent combination of education, experience and / or applicable military experience
  • Experience and knowledge of Claims, Medicare / Medicaid guidelines
  • Medical Terminology
  • Proficient in Microsoft Office Suite including Word (create, edit, save), Excel (create, edit, save), and Outlook (send & receive emails)
Soft Skills:
  • Able to handle emotionally charged phone calls and ability to deliver unfavorable claims outcome.
  • Ability to communicate effectively both verbally and in writing
  • Strong organization, planning, interpersonal and multi-tasking skills
  • Must be a self-starter and comfortable with confidential information
  • Attention to detail, strong problem-solving and time-management skills
  • Ability to work in a fast-paced environment, flexible and adaptable to changing situations, and a strong commitment to teamwork
  • Proven skills to establish rapport, trust and confidence with internal departments, staff and external vendors
  • Ability to remain calm in stressful situations and to conduct themselves in a professional manner at all times
  • Must be able to identify and define problems; collect data; establish facts and draw valid conclusions
Careers with LHI. Our focus is simple. We're innovators in cost-effective health care management. And when you join our team, you'll be a partner in impacting the lives of our customers, and employees. We've joined OptumHealth, part of the UnitedHealth Group family of companies, and our mission is to help the health system work better for everyone. We're located on the banks of the beautiful Mississippi River in La Crosse, Wis., with a satellite office in Chicago and remote employees throughout the United States. We're supported by a national network of more than 25,000 medical and dental providers. Simply put, together we work toward a healthier tomorrow for everyone. Our team members are selected for their dedication and mission-driven focus. For you, that means one incredible team and a singular opportunity to do your life's best work.

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: LaCrosse, Customer Service, Medical Coding, Medical Terminology, Appeals, claims

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