Welcome to 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<?xml:namespace prefix = "o" />
As a Customer Service and Claims Representative, you’ll be responsible for analyzing complex healthcare claims that require research to determine action steps and mathematical calculations necessary to produce an accurate payment. The claims position requires a high level of quality which is to be maintained while achieving a productivity goal. You’ll put your skills and talents to work as you review, research, and process medical claims. It's complex, detailed work. It's a fast-paced challenge. It's a job that calls on you to be thoughtful, resourceful, team-driven and customer-focused. To put it mildly, there is never a dull moment!
- Review, research, solve and process assigned work. This would include navigating multiple computer systems and platforms (e.g. verify pricing, prior authorizations, applicable benefits)
- Ensure that the proper benefits are applied to each claim by using the appropriate tools, processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/ certificates tool)
- Independently complete on a daily basis all documentation and communicate the status of claims as needed adhering to all reporting requirements
- Communicate through correspondence with members and providers regarding claim payment or required information, using clear, simple language to ensure understanding
- Learn and leverage new systems and training resources to help apply claims processes/procedures appropriately (e.g. on-line training classes, coaches/mentors)
- Meet and maintain the performance goals established for the position in the areas of quality, production and attendance
- An education level of at least a high school diploma or GED OR equivalent years of work experience
- Proficiency with Windows PC applications, which includes the ability to navigate multiple programs and learn new and complex computer system applications
- 1+ year of experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools
- 1+ year experience processing medical, dental, prescription or mental health claims
Making claims a positive experience for our members can drive your sense of impact and purpose. Join us as we improve the lives of millions. Learn more about how you can start doing your life’s best work.SM
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.
Key words: Healthcare, health care, Managed Care, Billing Representative, Billing, Collections, Claims, Customer Service, Medical Billing