Claims Adjustment Representative
About The Position
This position is Remote in Florida. You will have the flexibility to work remotely as you take on some tough challenges. 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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together. The health care system is still evolving at a rapid pace. Technology is driving new advances in how patient care is delivered and how it’s reimbursed. Now, UnitedHealth Group invites you to help us build a more accurate and precise approach to claims adjudication. In this role, you’ll be responsible for reviewing and making adjustments or corrections to processed claims through researching, investigating issues, making a determination and then communicating as required. Using multiple platforms, you’ll also assist with pricing verification, prior authorizations, benefits and coding. Join us and build your career with an industry leader.
Requirements
- High School Diploma / GED OR equivalent work experience
- Must be 18 years of age OR older
- 1+ years of experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools
- Ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills and learning new computer programs
- Ability to work full-time, Monday - Friday between 6:00am - 4:00pm CST including the flexibility to work occasional overtime given the business needs
- Reside within the state of Florida
- 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
- Ability to compose grammatically correct correspondence that translates medical and insurance expressions into simple terms that members can easily understand
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
- Candidates are required to pass a drug test before beginning employment.
Responsibilities
- Update claim information based on research and communication from member or provider
- Complete necessary adjustments to claims and ensure the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates)
- Communicate extensively with members and providers regarding adjustments to resolve claims errors/issues, using clear, simple language to ensure understanding
- Learn and leverage new systems and training resources to help apply claims processes/procedures
- Multitasking in this role is required to conduct data entry and rework, analyzing and identifying trends as well as completing reports daily.
Benefits
- a comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
