Claims Adjustment Representative

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.Review, research, analyze and process complex healthcare claims by navigating multiple computer systems and platforms and accurately capturing the data/information for processing (e.g. verify pricing, prior authorizations, applicable benefits). Receiving Real Time Adjustment calls from customers. Processing rework claims (e.g. reports, projects.This position is full-time, Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm. It may be necessary, given the business need, to work occasional overtime.This will be on the job training and the hours during training will be 8:00am to 5:00pm, Monday – Friday.Primary Responsibilities:

• Research, identify and obtain data/information needed to help process claims or resolve claims issues (e.g., verify pricing, prior authorizations, applicable benefits)
• Work is frequently completed with established Standard Operating Procedure documents
• 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
• Collaborate with internal business partners to resolve claims errors/issues (e.g., Subject Matter Experts, IT/systems staff)
• Achieve applicable performance metrics (e.g., productivity, quality, TAT, utilization)
• Use appropriate systems/platforms/applications to process claims
• Navigate systems tools and screens efficiently and effectively (e.g., keyboard skills, macros, shortcuts)
• Use appropriate documentation, reference materials and/or websites to ensure that claims are processed accurately and efficiently (e.g., policy/procedure manuals, knowledge libraries, bulletins, training materials, databases, SharePoint sites, data warehouses)
• Learn and use new systems/applications/resources as needed
• Applies knowledge/skills to a range of moderately complex activities
• Demonstrates great depth of knowledge/skills in own function
• Sometimes acts as a technical resource to others in own function
• Proactively identifies solutions to non-standard requests
• Solves moderately complex problems on own
• Works with team to solve complex problems
• Plans, prioritizes, organizes, and completes work to meet established objectives
• Identify and resolve claims processing errors/issues and trends, as needed (e.g., related to system configuration, network, eligibility, data accuracy, vendor-related, provider)
• Communicate and collaborate with external stakeholders (e.g., customer, vendors) to resolve claims errors/issues, using clear, simple language to ensure understanding

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.Required Qualifications:

• High School Diploma / GED OR equivalent work experience
• Must be 18 years of age OR older
• 1+ years of medical claims processing experience
• 1+ years of experience using Office 365 products (e.g., Excel, Word, Outlook)
• Experience with CPA or COSMOS to review and understand claims
• Experience working within Medical Insurance and/or Healthcare industries
• Ability to work a flexible 8-hour shift between the hours of 8:00am – 5:00pm including the flexibility to work occasional overtime.

Preferred Qualifications:

• Experience/knowledge using ISET, HOSTORS
• End to end understanding of the claims process
• Experience with SharePoint

Telecommuting Requirements:

• 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 PolicyPay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $17.74 – $31.63 per hour based on full-time employment. We comply with all minimum wage laws as applicable.Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes – an enterprise priority reflected in our mission.UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.

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