Claims Representative

UnitedHealth Group•Tampa, FL

21h•$18 - $32•Remote

About The Position

This position is National Remote. You’ll enjoy the flexibility to telecommute from anywhere within the U.S. 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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Positions in this function are responsible for providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims. Authorizes the appropriate payment or refers claims to investigators for further review. Conducts data entry and re-work; analyzes and identifies trends and provides reports as necessary.

Requirements

High School Diploma / GED OR equivalent work experience
Must be 18 years of age OR older
1+ years of healthcare claims experience
Ability to work 08:00AM – 04:30PM CST, Monday – Friday, including the flexibility to work occasional overtime, based on the business need (OT during peak season)

Nice To Haves

1+ years of experience processing medical, dental, prescription or mental health claims
Microsoft Office experience
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.

Responsibilities

Research, identify and obtain data/information needed to help process claims or resolve claims issues (e.g., verify pricing, prior authorizations, applicable benefits)
Ensure that proper benefits are applied to every claim
Apply knowledge of customer service requirements to process claims appropriately (e.g., Service Level Agreements, performance guarantees)
Identify and apply knowledge of new plans/customers to process their claims appropriately
Identify and resolve claims processing errors/issues and trends, as needed (e.g., related to system configuration, network, eligibility, data accuracy, vendor-related, provider)
Resolve or address new or unusual claims errors/issues as they arise, applying appropriate knowledge or prior experience
Communicate and collaborate with external stakeholders (e.g., members, family members, providers, vendors) to resolve claims errors/issues, using clear, simple language to ensure understanding
Collaborate with internal business partners to resolve claims errors/issues (e.g., Subject Matter Experts, Network Management, IT/systems staff, Compliance, vendor management teams, contract teams)
Document and communicate status of claims/investigations to stakeholders as needed, adhering to reporting requirements (e.g., status letters/reports)
Achieve applicable performance metrics (e.g., productivity, quality, TAT)