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Form of work
SalaryYou’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Accurately process professional claims
- Editing and adjusting of claims per the EDI daily audit report
- Analyze and adjudicate claims to ensure accurate payment
- Interpret Fee for Service (FFS) and capitated provider contracts
- Review claims on a periodic basis
- Meet Department Quality of 98.50% or better on a weekly and monthly basis. Meet production standard of 350 claims per day
- Interfaces with other departments such as eligibility, UM, Configuration to obtain necessary information required for resolution of claims
- Advise management of any claim issues or inappropriate and/or incorrect billing
- Other duties assigned by management
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:
- 2+ years of experience as a Medical Claims Examiner
- Medical Insurance Industry processing
- Working knowledge of Medical Terminology, ICD9, CPT4, UB92/1500 forms
- Excellent 10 key Data Entry skills
Preferred Qualifications:
- 1+ years of experience of professional claims processing
- Medicare, HMO experience
- Experience in contract interpretation
- CPT and HCPCS coding
- All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, or Washington residents is $16.54 to $32.55 per hour. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
