Senior Claims Examiner - Remote

Company: UnitedHealth Group
Location: San Diego
Posted on: November 20, 2023

Job Description:

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring and join us to start Caring. Connecting. Growing together. -

This is a challenging role that takes an ability to thoroughly review, analyze, and research complex health care claims in order to identify discrepancies, verify pricing, confirm prior authorizations, and process them for payment. You'll need to be comfortable navigating across various computer systems to locate critical information. Attention to detail is critical to ensure accuracy which will ensure timely processing of the member's claim.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. -

Primary Responsibilities:

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• Assist with escalated claims to resolve complex issues for team members and internal customers
  
• Support implementation of updates to the current procedures and assist with new system training/mentoring
  
• Review guidelines as well as benefit plan documents and certificates to ensure proper benefits have been applied to each claim
  
• Analyze and identify trends and provides reports as necessary
  
  -This is a challenging role that takes an ability to thoroughly review, analyze and research complex health care claims in order to identify discrepancies, verify pricing, confirm prior authorizations and process them for payment. -
  You'll need to be comfortable navigating across various computer systems to locate critical information. Attention to detail is critical to ensure accuracy which will ensure timely processing of the member's claim.
  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:
  
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  • High school diploma or GED OR equivalent years of work experience
    
  • 3+ years of experience in a related environment (i.e., office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools
    
  • 3+ years of experience in FACETs
    
  • 1+ years of experience processing medical, dental, prescription or mental health claims
    
  • Proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications -
    
    Preferred Qualifications:
    
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    • Proven exceptional ability to organize, prioritize and communicate effectively
      
      *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy. -
      California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington residents is $18.80 to $36.78 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: 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. -
      

Keywords: UnitedHealth Group, San Diego , Senior Claims Examiner - Remote, Other , San Diego, California