Flexible? Friendly? Fast on your feet? That's a great start. Accurate? Accountable? Self Directed? These traits can take you places. Our claims operations are the focal point of handling information about services patients receive and the way those services get paid. It's complex, detailed work. It's 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.
The Senior Claims Representative reviews, analyzes, investigates, makes liability decisions and approves the release of benefit payments up to authorized levels on initial, continued and reopened claims.
- Evaluates new and on - going claims to determine liability, giving consideration to contract provisions, disability management duration contract guidelines, medical evidence and vocational evidence.
- Investigates questionable claims. Determines need for additional medical information.
- Performs periodic follow - ups to verify continued existence of a disabling condition.
- Responds to telephone and written inquiries from claimants, attorneys, physicians and policyholders.
- Identifies and forwards claims to specialized internal and external resources in areas such as rehabilitation, investigations, medical exams, settlements and Social Security.
- Keeps track of time frames required of mandated correspondence.
- This level is responsible for reviewing routine claims for adjudication purposes. Refers more complex claims to higher levels.
- High School Diploma / GED or higher
- Proficiency with 10 key typing skills
- Proficiency with Microsoft Word (ability to create and edit documents)
- Basic knowledge of case law and state Worker’s Compensation laws, subrogation, reserve setting, and litigation management
- 1 + year of experience managing or adjudicating Workers Compensation claims
- Proficiency with Microsoft Excel (ability to filter, sort, attach and edit spreadsheets)
- Proficiency with Microsoft Outlook (ability to receive, send emails)
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.
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