Claims Representative - Remote in PST
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About The Position
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. If you are located within Pacific Standard Time Zone, you will have the flexibility to work remotely* as you take on some tough challenges.
