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Responsible for all aspects of assigned cases for analyzing and appeal / dispute process of conditional payments.
- High School Diploma / GED or higher
- 3+ years of complex Claims experience (i.e. Worker’s Compensation / Auto / Liability, Case Management, High Dollar Claims, Medicare Secondary Payor Services)
- Ability to create and edit professional documents in Microsoft Word
- Ability to create and edit spreadsheets in Microsoft Excel
- Ability to use Outlook to send and create emails
- Knowledge of / work experience utilizing ICD9 / ICD10 coding
- Medical terminology understanding
- Associate's Degree or higher
- Medical, Paralegal, Adjuster background or prior Conditional Payment Negotiation experience
- Previous Medicare Secondary Payer Recovery experience
- Previous Medical Claims Appeals experience
- Ability to work in a fast paced environment
- Ability to manage one's own time and work with a team
- Must have strong organizational skills, detail oriented and focus on meeting deadlines
- Strong written and verbal communication skills
- Ability to analyze legal and medical documentation to assist with formulating dispute and appeal letters
Physical Requirements and Work Environment:
- Extended periods of sitting at a computer and use of hands / fingers across keyboard or mouse
- Office environment
OptumRx is an empowering place for people with the flexibility to help create change. Innovation is part of the job description. And passion for improving the lives of our customers is a motivating factor in everything we do.
If you're ready to talk about groundbreaking interactions, let's talk about what happens when a firm that touches millions of lives decides to gather results from millions of prescriptions every month and analyze their impact. Let's talk about smart, motivated teams. Let's talk about more effective and affordable healthcare solutions. This is caring. This is great chemistry. This is the way to make a difference. We're doing all this, and more, through a greater dedication to our shared values of integrity, compassion, relationships, innovation and performance. Join us and start doing your life’s best work.SM
Diversity creates a healthier atmosphere: United Health 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.
United Health Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
Keywords: United Health Group, United Health Care, Claims, Processing, Customer Service, Analyst, Audit, Pharmacy, Medical