Claims Adjustment Representative - Abingdon, VA

If you are in Abingdon, VA, you will have the flexibility to work from home and the office in this hybrid role* as you take on some tough challenges.

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 equitable. Ready to make a difference? Join us and start doing your life’s best work.SM

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. As a Specialist, you’ll be responsible for reviewing and making adjustments or corrections to processed claims through researching, investigating issues and making and communicating determinations. You’ll authorize the appropriate adjustment ensuring compliance with all requirements and serve as a point of contact for questions/escalations from internal and external customers. Join us and build your career with an industry leader.

As a Claims Adjustment Representative you will be required to effectively manage workers compensation claims from beginning investigation and compensability determination through to return to work or resolution through settlement and claim closure. You will maintain close continual contact with the injure workers, client contacts and medical providers as necessary and document all actions on the claim narrative.

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 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime.

Our office is located at 191 Johnson Street, Abingdon VA. Employees will be required to work 1 day onsite and 4 days from home.

We offer weeks of on-the-job training. The hours during training will be 8:00am to 5:00pm, Monday - Friday.

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

Primary Responsibilities:

• Review new claims on designated client accounts and establish a plan of action to achieve favorable claim resolution.
• Make compensability and/or liability determinations on indemnity claims.
• Establish reserves utilizing Official Disability Guidelines, calculate indemnity benefits, pursue subrogation, report to excess carriers, and discuss strategies with legal counsel.
• Consult with clients to understand their needs and goals.
• Provide status reports to customers and keep Account Executives and Claims Manager informed.
• Advocate, consult and provide advice to clients as appropriate.
• Investigate, evaluate and negotiate resolution of large and/or complex claims in accordance with company guideline and best claims practices.

This is a challenging role with serious impact. You’ll be providing a senior level of support and subject matter expertise within a fast paced, intense and high volume claims operation where accuracy and quality are essential.

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
• 1+ years of experience in a related environment (i.e. claims administration, office administrative, clerical, customer service, etc.) using phones and computers as the primary job tools
• Experience with Microsoft Word (creating and editing documents)
• Ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills and learning new computer programs
• Ability to travel up to 10% of the time
• Must be 18 years of age OR older
• Ability to work full-time, Monday - Friday between 8:00am - 5:00pm including the flexibility to work occasional overtime given the business need

Telecommuting Requirements:

• Reside within commutable distance of 191 Johnson Street, Abingdon, VA
• 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.

Soft Skills:

• Ability to compose grammatically correct correspondence that translates medical and workers compensation expressions into simple terms that members can easily understand

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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