Senior Claims 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.

Opportunities at WellMed, part of the Optum family of businesses. We believe all patients are entitled to the highest level of medical care. Here, you will join a team who shares your passion for helping people achieve better health. With opportunities for physicians, clinical staff and non-patient-facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.

The Senior Claims Representative will be responsible for receiving and reviewing cases to determine if medical records need to be requested for further review.

This telecommuter position is full time, Monday – Friday. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8:00 AM – 5:00 PM local time zone. It may be necessary, given the business need, to work occasional overtime.

We offer 2 weeks of paid training. The hours during training will be 8:00 AM – 5:00 PM local time zone from Monday – Friday.

 

Primary Responsibilities:

• Triaging of medical records (e.g., misroutes)
• Determine claims that require medical records for review
• Create medical records request letters
• Receive and document medical records within case tracking system
• Work cases that do not require medical records for review (e.g., hold claims, adjusted claims, etc.)
• Prepare cases to move to clinical teams
• Ensure adherence to federal compliance policies, contract compliance
• Collaboration with clinical investigator, legal and compliance for case review
• Ability to adapt in a dynamic and high – growth environment
• Ability to work independently

 

In 2011, WellMed partnered with Optum to provide care to patients across Texas and Florida. WellMed is a network of doctors, specialists and other medical professionals that specialize in providing care for more than 1 million older adults with over 16,000 doctors’ offices. At WellMed our focus is simple. We’re innovators in preventative health care, striving to change the face of health care for seniors. WellMed has more than 22,000+ primary care physicians, hospitalists, specialists, and advanced practice clinicians who excel in caring for 900,000+ older adults. Together, we’re making health care work better for everyone.

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
• Must be 18 years of age OR older
• 1+ years of health insurance claims experience
• 1+ years of experience with working in a production environment with metrics and QA standards
• 1+ years of experience in Microsoft Word and Microsoft Excel
• Ability to work any of our shift schedules during our normal business hours of 8:00 AM – 5:00 PM local time zone from Monday – Friday. It may be necessary, given the business need, to work occasional overtime.

 

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 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 $20.00 – $35.72 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.

 

 

OptumCare 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.

 

OptumCare is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.

 

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