Claims Representative – Remote in Pacific Time Zone

If you are located within Pacific Time Zone, you will have the flexibility to telecommute* (work from home) 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 diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

As a Claims Representative the position is a high production claims processing that     Claims will be submitted through a que from members, pharmacy, and providers and claims are researched based on plan and benefits are confirmation for payment.   You will be processing the claims to pay back the member, Pharmacy or Provider and will need to recognize the ask for the reimbursement.     

Metrics are based on the line of business you are assigned to and is based off weekly and monthly and will vary depending on the business.

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 7:30am-4:30pm PST. It may be necessary, given the business need, to work occasional overtime that include possible holiday based on needs.

We offer 4-8 weeks of paid training. The hours during training will be 7:30am-4:00pm PST, Monday – Friday. Training will be conducted virtually from your home.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

• Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing, and adjusting claims.
• Analyze and identify trends and provide reports as necessary.
• Consistently meet established productivity, schedule adherence, and quality standards

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  
• 18 years of age or older
• 3+ years of experience in an office, healthcare, or pharmacy environment
• Familiarity with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications.
• Ability to work from 7:30 am – 4:00 pm PST, Monday through Friday with overtime, that can include weekends and holidays as needed.

Preferred Qualifications:

• 1+ years of experience in processing claims 
• 1+ years of Medicare knowledge

Telecommuting Requirements:

• Reside within Pacific Time Zone
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• Ability to keep all company sensitive documents secure (if applicable)
• 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:

• Critical thinking skills
• Ability to work independently and in a team environment.
• Flexibility and the ability to change between different tasks as needed.
• High personal accountability
• Professional communication skills 

Physical and Work Environment:

• Extended periods of sitting at a computer and use of hands / fingers across keyboard or mouse
• Office environment

California, Washington and Nevada Residents Only: The hourly range for this is $16.54 – $32.55 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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.

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