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Claims Adjustment Representative

Company UnitedHealth Group
Location Cypress, CA 90630
Update 9 Day ago
Position Description:
Energize your career with one of Healthcare’s fastest growing companies.

You dream of a great career with a great company - where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.

This opportunity is with one of our most exciting business areas: Optum - a growing part of our family of companies that make UnitedHealth Group a Fortune 17 leader.

Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation and Performance.

We are a small, but critical team processing commercial claims for a large state employer.

Primary Responsibilities:
Research, identify and obtain data / information needed to help process claims or resolve claims issues

Ensure that proper benefits are applied to every claim

Apply knowledge of customer service requirements to process claims appropriately

Identify and apply knowledge of new plans / customers to process their claims appropriately

Identify and resolve claims processing errors / issues and trends, as needed

Resolve or address new or unusual claims errors / issues as they arise, applying appropriate knowledge or prior experience

Communicate and collaborate with external stakeholders to resolve claims errors / issues, using clear, simple language to ensure understanding

Collaborate with internal business partners to resolve claims errors / issues

Document and communicate status of claims / investigations to stakeholders as needed, adhering to reporting requirements

Achieve applicable performance metrics

Apply appropriate processes and procedures to process claims (e.g., claims processing policies and procedures, grievance procedures, state mandates, CMS / Medicare guidelines, benefit plan documents / certificates)

Leverage training resources to help apply claims processes / procedures appropriately

Collaborate with business partners to help address identified issues related to claims processes and procedures

Identify / develop / implement new claims processes procedures / solutions as needed, and document appropriately for future use

Demonstrate knowledge of applicable product / service offerings, and the value they provide to members and providers

Keep current on new product / service offerings and the value they provide

Demonstrate knowledge of benefit plan provisions and keep current on changes as they occur

Communicate the value of our products and services to applicable audiences, using clear, simple language to ensure understanding

Apply knowledge of products and services to process claims appropriately

Required Qualifications:
High School Diploma / GED

2+ years of medical claims processing experience

6+ months of medical coding experience (ICD-9, ICD-10, CPT, etc.)

Knowledge of applicable laws, regulations and compliance requirements to ensure that claims are processed properly (e.g., HIPAA, PPACA / Health Care Reform)

Must successfully complete new hire training courses

Experience manually adjudicating a claim

Preferred Qualifications:
Experience processing claims on the United Healthcare NICE claims platform
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So, when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.

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.