Claims Representative Associate

This position follows a hybrid schedule with two – three (2 – 3) in-office days per week. Our office is located at 3131 Camino Del Rio N, Ste 700, San Diego, CA, 92108.

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

To provide leadership and support to the Team by analyzing current processes, problem solving, designing new processes and implementing improvement.  Works directly with our vendor, our internal systems team, and outside vendors to transfer data and develop procedures.  Works directly with the processing team to assist with obstacles and to train them in process improvements.

Imagine this. Every day, in claims centers around the world, UnitedHealth Group is processing and resolving payment information for millions of transactions. Would you think we have some great technology? Would you think we know how to manage volume? You would be right. No one’s better. And no company has put together better teams of passionate, energetic and all out brilliant Claims Representative Associates. This is where you come in. We’ll look to you to maintain our reputation for service, accuracy and a positive claims experience. We’ll back you with great training, support and opportunities.

This position is full time (40 hours / week), Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:30 AM – 5:00 PM PST. It may be necessary, given the business need, to work occasional overtime.

Primary Responsibilities:

• Review, examine, and adjudicate each claim in its entirety within program requirements
• Ensures each claim is adjudicated in an accurate and timely manner to meet and exceed established production and quality standards
• Make and accept necessary phone calls to facilitate claims processing
• Other duties, as assigned, to meet the needs of the department and our customers

This is a challenging role that takes an ability to thoroughly review, analyze and research complex health care claims 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 impact the timely processing of the member’s claim.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School Diploma / GED OR equivalent work experience 
• Must be 18 years of age OR older
• 3+ years of experience with direct experience in claims processing and scrubbing with increasing levels of complexity and responsibility
• Experience with medical terminology, ICD – 10, and CPT coding methodologies
• Experience in the processing of all claim types
• Experience with Microsoft Office (Microsoft Word, Microsoft Excel, Microsoft Outlook, and Microsoft Teams)
• Valid Driver’s License
• Access to reliable transportation
• Ability to travel up to 25% of the time
  
• Ability to work any of our full time (40 hours / week), 8-hour shift schedules during our normal business hours of 8:30 AM – 5:00 PM PST from Monday – Friday. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications:

• 1+ years of experience in a related environment (i.e., office, administrative, clerical, customer service, etc.) using phones and computers as primary job tools
• 1+ years of experience with processing medical, dental, prescription, OR mental health claims
• Knowledge with medical terminology, ICD – 10, CPT, and National Correct Coding Initiatives (NCCI)
• IDX system experience

Telecommuting Requirements: 

• Reside within commutable distance to the office at 3131 Camino Del Rio N, Ste 700, San Diego, CA, 92108 
• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $16.00 – $27.69 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.

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