This is an opportunity that’s all about where you've been. Your experience. Your potential. Your skills. Because on the team at UnitedHealth Group, your potential and your impact can be career changing. No company has put together better teams of passionate, energetic, and all-out brilliant Claims Examiners. This is where you come in. We'll look for your experience and expertise to help keep our service levels and accuracy extremely high. We'll also look for your ideas on how to constantly evolve our claims processes. We'll back you with the great training, support, and opportunities you'd expect from a Fortune 5 leader.
- Assist with escalated claims to resolve complex issues for team members and internal customers
- Support implementation of updates to the current procedures and assist with new system training/mentoring
- Review guidelines as well as benefit plan documents and certificates to ensure proper benefits have been applied to each claim
- Analyze and identify trends and provide reports as necessary
This is a challenging role that takes an ability to thoroughly review, analyze, and research complex health care claims in order to identify discrepancies, verify pricing, confirm prior authorizations, and process them for payment. You'll need to be comfortable navigating across various computer systems to locate critical information. Attention to detail is critical to ensure accuracy which will ensure timely processing of the member's claim.
At least a high school diploma/GED
3+ years 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(s) of experience processing medical, dental, prescription, and/or mental health claims
Proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
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 with WellMed. Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 240,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do 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.
Job keywords: health care, healthcare, managed care, Medicare, medical claims, medical billing, claims processing, claims examination, WellMed, San Antonio, Texas, TX