Commercial COB Auditor - San Juan, PR

UnitedHealth Group

1d

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.
The COB Representative is responsible for resolving escalated provider and member issues. The successful COB Representative will perform root cause analysis, determine primacy, and update all systems to ensure that claims are processed correctly.

Requirements

• 2+ years of experience with data entry
• 2+ years working in a production environment
• 1+ years of experience working in the health care industry (claims healthcare)
• 1+ years of experience analyzing and solving customer problems
• Experience with Microsoft Excel
• Demonstrated exemplary verbal and written communication skills in English
• Ability to work 40 hours weekly from Monday to Friday during our regular business hours from 7am to 6pm (Overtime as business needs dictate)
• ENGLISH PROFICIENCY ASSESSMENT WILL BE REQUIRED AFTER APPLICATION

Nice To Haves

• Experience in an inbound/outbound
• Coordination of benefits experience
• Experience working in the health care industry
• Experience using platforms such as UNET, Pulse, NICE, Facets, Diamond, etc.

Responsibilities

• Verify other insurance coverage primarily through payer portals and clearinghouse portals, but also occasionally leverage automated phone lines, databases, or phone outreach to commercial payers
• Data entry of other insurance coverage findings into internal applications
• Work directly with other departments to enhance and refine assigned inventory to maximize value
• Knowledge and application of Medicare and NAIC coordination guidelines to properly coordinate members
• Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
• Use pertinent data and facts to identify and solve a range of problems within area of expertise
• Serves as a resource to others
• Data entry into client submission systems
• Other duties as assigned

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed