Claims Representative Associate

Claims Adjudication Specialist

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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing Together.

The health care system is still evolving at a rapid pace. Technology is driving new advances in how patient care is delivered and how it's reimbursed. Now, UnitedHealth Group invites you to help us build a more accurate and precise approach to claims adjudication. In this role, you'll be responsible for reviewing and making adjustments or corrections to processed claims through researching, investigating issues, making a determination and then communicating as required. Using multiple platforms, you'll also assist with pricing verification, prior authorizations, benefits and coding. Join us and build your career with an industry leader.

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 6 : 00 AM - 6 : 00 PM candidate's local time zone after core metrics are met. It may be necessary, given the business need, to work occasional overtime or weekends.

We offer 14 weeks of paid training. The hours of the training will be 7 : 00 AM - 3 : 30 PM CST from Monday - Friday. 100% attendance is required and No PTO during training. Training will be conducted virtually from your home.

Primary Responsibilities :

• Update claim information based on research and communication from member or provider
• 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 guidelines, benefit plan documents / certificates)
• Communicate extensively with members and providers 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

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 :

Telecommuting Requirements :

Soft Skills :

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). The hourly pay for this role will range from $16.00 - $27.69 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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.