Claims SME (HCBS) - San Juan, PR

UnitedHealth Group•San Juan, PR

5d•Onsite

About The Position

This is an opportunity that's all about where you've been. Your experience. Your potential. Your skills. Because on the team at UnitedHealth Group, your potential and your impact can be career changing. No company has put together better teams of passionate, energetic and all out brilliant Claims Representatives. This is where you come in. We'll look for your experience and expertise to help keep our service levels and accuracy extremely high. We'll also look for your ideas on how to constantly evolve our claims processes. We'll back you with the great training, support and opportunities you'd expect from a Fortune 5 leader. The SME from the Claims department will update the applicable UHC systems that impact claim payment. Other responsibilities include: conducting audits and providing feedback to reduce errors and improve processes and performance, and may be responsible for representing the W&E area on operational excellence and improvement projects. Supports training for process knowledge training to current and new associates.

Requirements

1+ years of experience in the healthcare industry
1+ years of experience in a production environment
1+ years of experience analyzing and solving customer problems in an office or customer service environment
6+ months of experience working in HCBS claims processing
Microsoft Excel proficiency (filter, sort, create and edit spreadsheets)
Proficient in verbal and written English skills

Nice To Haves

Training experience
Knowledge of Managed Care/ Medicaid / Medicare / Commercial rules and regulations
Inventory and audit management
Proven ability to utilize complex database systems and claims platforms simultaneously including (Ex. CSP Facets)
Proven problem and Analytical Skills
Proven ability to work independently and as a team player

Responsibilities

Ability to handle most claim types / rework / issues that are submitted to the team you are supporting
Manage team Questions / Escalations SharePoint / Email
Submit requests to have information validated or requested
Submit system issues
Submit P&P update requests
Submit new macro requests or macro requests
Review team quality rebuttals and support team remediation plans / initiatives
Perform desk visits or coaching and development for team members as needed
Complete required individual development courses / trainings
Meet and maintain minimum quality and productivity standards
Provide assistance managing team and department workflow
Host / Attend meetings such as, but not limited to: Quality related meetings, P&P Calls, SME meetings