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. 

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 equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

This position is 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 (8:00am – 5:00pm). It may be necessary, given the business need, to work occasional overtime.

We offer 15 weeks of paid training. The hours during training will be 8am to 4:30pm CST (hours subject to change), Monday – Friday. Training will be conducted virtually from your home. 100% attendance is a must during training period

 

Primary Responsibilities:

• Update claim information based on research and communication from provider, Health Plans, or state compliance offices.
• Complete necessary adjustments to claims and ensure the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare/Medicaid guidelines, benefit plan documents)
• Communicate extensively with Heath Plans & Internal Business Partners regarding adjustments to resolve claims errors/issues, using clear, simple language to ensure understanding.
• Learn and leverage new systems and training resources to help apply claims processes/procedures
• Ensure claim turnaround times are met and work toward metric deliverables

 

This is a challenging role with serious impact. You’ll be providing a high level of support and subject matter expertise within a fast paced, intense and high volume claims operation where accuracy and quality are essential. Multitasking in this role is required to conduct data entry and rework, analyzing and identifying trends as well as completing reports daily.

 

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
• 6+ months of claim processing experience or medical or insurance experience
• Knowledge of Medicare/Medicaid processes
• Ability in using computer and Windows 365 applications, which includes the ability to learn new applications  
• 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 (8:00am – 5:00pm). It may be necessary, given the business need, to work occasional overtime.

 

Preferred Qualifications: 

• 1+ years of experience of Medicaid and Medicare policies and regulations
• 2+ years of experience processing original claims or reworks
• Claim processing experience in Facets (CSP Platform)  
• Claim experience working in Work Distribution Application
• Intermediate experience working with Microsoft Teams
• Intermediate experience working with Microsoft Outlook
• Intermediate experience working with Microsoft PowerPoint
• Intermediate experience working with Microsoft Excel (sorting data, basic formulas, v-lookup, and pivot tables) 

 

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.

 

Soft Skills:

• Ability to compose grammatically correct correspondence that translates medical and insurance expressions into simple terms that members can easily understand
• Results-oriented
• Verbal & Written Communications
• Solution Oriented
• Detail Oriented
• Critical thinking

 

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

 

Pay 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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