Medical Claims Representative

UnitedHealth Group•Las Vegas, NV

2d•$18 - $32•Onsite

About The Position

This position is Onsite. Our office is located at 2720 N Tenaya Way, Las Vegas, NV, 89128. 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 Medical Claims Representative works under minimal supervision adjudicating complex and specialty claims. They release designated pending claims to achieve established production, quality, and cycle time standards in accordance with EOC, Benefit Schedules and contractual arrangements. They monitor and report desk inventory notifying management of problem identification. This role is primarily focused on claims analysis and adjudication and does not include inbound or outbound customer service phone responsibilities. If you're looking for a role where you can leverage your skills to connect people, translate ideas into action, and drive meaningful outcomes, this could be the perfect fit. What are the reasons to consider working for UnitedHealth Group? Put it all together - a highly competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success.

Requirements

High School Diploma / GED OR equivalent years of work experience
Must be 18 years of age or older
1+ years of medical claims processing experience in working with HMO / PPO or indemnity claims
1+ years of experience with Medical terminology, ICD-10, or CPT coding with an understanding of Insurance Certificates, Benefit Schedules, Provider / Group Contracts and Standard Insurance Industry Practices
Must be willing to interview onsite at 2720 N. Tenaya Way, Las Vegas, NV, 89128
Must be willing to work onsite at 2720 N. Tenaya Way, Las Vegas, NV, 89128
Ability to work full time (40 hours / week), Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 6:00 am - 5:00 pm. Alternate schedules are available for those who would prefer to work four 10-hour shifts from Monday - Friday as long as employees are working the hours per business need. It may be necessary, given the business need, to work occasional overtime.
Must possess understanding of basis mathematics
Knowledge of, or capacity to learn and apply, applicable federal and state laws, regulations, policies, and industry guidelines related to healthcare claims processing and operational compliance
Experience working in a high-volume production environment while consistently meeting established productivity and quality standards
Demonstrated analytical reasoning, critical thinking, and problem-solving skills
Adaptability to change and flexibility are key to success in the role, along with the ability to maintain a positive work ethic

Nice To Haves

2+ years of medical claims processing experience in working with HMO / PPO or indemnity claims
2+ years of experience with Medical terminology, ICD-10, or CPT coding with an understanding of Insurance Certificates, Benefit Schedules, Provider / Group Contracts and Standard Insurance Industry Practices
1+ years of experience in Medical / Dental insurance, office or medical billing setting

Responsibilities

Adjudicate claims in accordance with established quality and production standards
Monitor work inventory and submits required reports accurately and by established deadlines
Analyze medical claims to ensure accurate adjudication in accordance with Evidence of Coverage (EOC) documents, Benefit Schedules, and Provider Contracts
Release claims within established timeframes to meet company requirements, state regulations, contractual obligations, and performance standards
Identify processing issues and reports findings to management
Resolve priority projects and complex assignments
Perform all job functions with a high degree of discretion and confidentiality in compliance with federal, company, and departmental confidentiality guidelines

Benefits

18 days of Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
Medical Plan options along with participation in a Health Spending Account or a Health Saving account
Dental, Vision, Life& AD&D Insurance along with Short-Term disability and Long-Term Disability coverage
401(k) Savings Plan, Employee Stock Purchase Plan
Education Reimbursement - up to $5,250 per calendar year for job-related coursework
Adoption Assistance Plan
Employee Discounts
Employee Assistance Program
Employee Referral Bonus Program
Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)