Review, research, solve and process assigned work. This would include navigating multiple computer systems and platforms (e.g. verify pricing, prior authorizations, applicable benefits) Ensure that the proper benefits are applied to each claim by using the appropriate tools, processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/ Medicare guidelines, benefit plan documents/ certificates tool) Independently complete daily all documentat... more details
If you are located within the state of New York, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges.
At UnitedHealthcare, were 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 and start doing your lifes best work.SM
As an Associate Claims Representative youll be responsible for analyzing complex healthcare claims that require research to determine action steps and mathematical calculations necessary to produce an accurate payment.?You will complete daily all documentation and communicate the status of claims as needed as well as review, research, solve and process assigned work.
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 6am 6pm EST. It may be necessary, given the business need, to work occasional overtime.
We offer 4-6 weeks of paid training. The hours during training will be 8am 4:30 pm EST, Monday - Friday.
*All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.
Primary Responsibilities:
- Review, research, solve and process assigned work. This would include navigating multiple computer systems and platforms (e.g. verify pricing, prior authorizations, applicable benefits)
- Ensure that the proper benefits are applied to each claim by using the appropriate tools, processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/ certificates tool)
- Independently complete daily all documentation and communicate the status of claims as needed adhering to all reporting requirements
- Learn and leverage new systems and training resources to help apply claims processes/procedures appropriately (e.g. on-line training classes, coaches/mentors)
- Meet and maintain the performance goals established for the position in the areas of quality, production and attendance
- Consistent attendance with ability to meet work schedule including the required training period
- Successful completion of the UnitedHealth Group 4-6 week new hire training program
- Additional responsibilities will be keying claims, pre-determination and SMARTSQ
Youll 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
- 1+ years of experience with UNET claims
- Working knowledge with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications (including comfort using macros efficiently)
- Experience navigating multiple programs/platforms and/or screens
- Experience working with multiple monitors
- 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 6:00am - 6:00pm EST. It may be necessary, given the business need, to work occasional overtime.
Preferred Qualifications:
- Experience working with multiple products and multiple levels of benefits within each product
Telecommuting Requirements:
- Reside within the state of New York
- 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.
New York Residents Only: The hourly range for this is $16.00 - $28.27 per hour. Pay is based on several factors including but not limited tolocal 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, youll 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 everyoneof every race, gender, sexuality, age, location, and incomedeserves 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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