Claims Adjuster – Charleston, WV

Requisition Number: 2257773
Job Category: Claims
Primary Location: Charleston, WV, US

UMR, UnitedHealthcare’s third-party administrator (TPA) solution, is the nation’s largest TPA. When you work with UMR, what you do matters. It’s that simple . . . and it’s that rewarding.
In providing consumer – oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system. Opportunities are endless for your career development and advancement within UMR due to our record-breaking growth.
Regardless of your role at UMR, the support you feel all around you will enable you to do what you do with energy, quality, and confidence. So, take the first step in what is sure to be a fast – paced and highly diversified career.
 
This position is full-time (40 hours/week) Monday – Friday. Employees are required to work during our normal business hours of (_8:00am – _4:30pm) EST. It may be necessary, given the business need, to work occasional overtime. Our office is located at 602 Virginia Street East, Charleston WV
  
 
Primary Responsibilities:
  • Review new Self-Insured claims on designated client accounts and determine compensability, establish reserves, review for subrogation, authorize medical treatment, establish a plan of action to achieve favorable claim resolution.
  • Handle all aspects of Self-Insured injury claims
  • Recommend high level claim strategies to clients 
  • Refer claims to defense counsel and work with them regarding litigation management  
  • Attend and facilitate client meetings and claim reviews.
  • Review claims status and action plans using advanced problem resolution skills.
  • Provide status reports to clients.
  • Investigate, evaluate and negotiate resolution/settlement of some claims in accordance with state workers’ compensation laws.
  • Actively plans, prioritizes and tracks work status
  • Assigns tasks to medical bill processors, payee specialists and others who work with the adjuster on claims
  • Develops timeline and milestones
  • This role requires the ability to adapt to changing needs of the programs they support, including the ability to analyze the changing demands of the clients and develop new processes/ procedures to support their needs. 
  • This position may require travel to client locations for claim reviews 
  
 
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.
  • 2+ years of experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) analyzing and solving customer problems
  • Experience with Microsoft Excel (create and edit spreadsheets), Microsoft Word (create and edit documents), Microsoft Outlook (manage e-mail)
  • Familiarity with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
  • Willingness to obtain adjuster license in states that require licensure within 6 months of assignment to that state.
  • Must reside within a commutable distance to the office located at  602 Virginia Street East, Charleston WV and travel to client locations
  • Ability to work during our normal business hours of (_8:00am – _4:30pm) EST. It may be necessary, given the business need, to work occasional overtime. 
 
 
  Preferred Qualifications
  • 1+ years of claims adjuster experience 
  
 
Soft Skills
  • Strong written and communication skills
  • Ability to manage a desk of heavily litigated claims, including the ability to file Motions, Appeals, Objections and Answers to Motions and coordinating with outside council when necessary and appropriate
  • Able to balance strategic thinking with the urgency to drive work forward
  • Solid problem-solving skills and ability to derive structure and clarity from ambiguous or open-ended inputs
  • A growth mindset is required for this new growing business and requires a person who is open to taking on new challenges and embracing them
   
 
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.
 
 
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
 
UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.
 
#RPO #RED

Additional Job Detail Information

Requisition Number 2257773

Business Segment UnitedHealthcare

Employee Status Regular

Job Level Individual Contributor

Travel No

Country: US

Overtime Status Non-exempt

Schedule Full-time

Shift Day Job

Telecommuter Position No

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