Claims Representative

This position is Remote in Pacific Standard Time Zone, you will have the flexibility to work remotely* as you take on some tough challenges.

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

Claims Representative within Manual Claims department focusing on DMR’s and provider claims across all lines of business. This position focuses on both claims processing efficiency and accuracy in order to meet compliance. Impact of lack of staff for this role could create PG penalties or IRE’s and impact company STAR ratings and lead to financial penalties. Lettering delays, member experience and payment delays could also be impacted. Skills needed include understanding claims processing and the RxCLAIM and web view applications. This role is unable to be absorbed due to the compliance nature of the role including on-shore restrictions and Medicare Compliance risks. This is a non-discretionary request based on claims volume and available resource capacity to meet existing performance guarantees. Through planned reduction we are currently operating above capacity due to surges in PTO Needs, FMLA and to support ongoing volume to continue adherence to client commitments.

This position is full-time (40 hours/week). Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:30am – 4:00pm PST, Monday – Friday. It may be necessary, given the business need, to work occasional overtime and holidays.

We offer 4 – 8 weeks of on-the-job training. The hours during training will be an 8-hour shift between 7:30am to 4:00pm PST, Monday – Friday. Training will be conducted virtually from your home.

Primary Responsibilities:

• Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing, and adjusting claims.
• Analyze and identify trends and provide reports as necessary.
• Consistently meet established productivity, schedule adherence, and quality standards.

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
• Must be 18 years of age OR Older
• 3+ years of experience in an office, healthcare, or pharmacy environment
• Familiarity with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
• Ability to work any of our 8-hour shift schedules during our normal business hours of 7:30am – 4:00pm PST, Monday – Friday. It may be necessary, given the business need, to work occasional overtime and holidays

Preferred Qualifications:

• 1+ years of experience in processing claims
• 1+ years of Medicare knowledge

Telecommuting Requirements:

• Reside within Pacific Standard Time Zone
• 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.

Soft Skills:

• Critical thinking skills
• Ability to work independently and in a team environment
• Flexibility and the ability to change between different tasks as needed
• High personal accountability
• Professional communication skills

Physical and Work Environment:

• Extended periods of sitting at a computer and use of hands / fingers across keyboard or mouse
• Office environment

*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 $17.74 – $31.63 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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