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  • Long Island, NY

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Claims Adjustment Representative - NY Telecommute

UnitedHealth Group • Long Island, NY

Posted 17 days ago

Job Snapshot

Full-Time
Healthcare - Health Services
General Business, Health Care

Job Description

If you’re located in New York state, you will have the flexibility to telecommute* as you take on some tough challenges. The health care system is still evolving at a rapid pace. 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. In this role, you’ll be responsible for reviewing and making adjustments or corrections to processed claims through researching, investigating issues, making a determination and then communicating as required. Using multiple platforms, you’ll also assist with pricing verification, prior authorizations, benefits and coding. Join us and build your career with an industry leader.


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 (6:00am to 6:00pm). It may be necessary, given the business need, to work occasional overtime.


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


Primary Responsibilities

  • Update claim information based on research and communication from member or provider
  • Complete necessary adjustments to claims and ensure the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates)
  • Communicate extensively with members and providers regarding adjustments to resolve claims errors/issues, using clear, simple language to ensure understanding
  • Learn and leverage new systems and training resources to help apply claims processes/procedures

This is a challenging role with serious impact. You’ll be providing a high level of support and subject matter expertise within a fast paced, intense and high volume claims operation where accuracy and quality are essential. Multitasking in this role is required to conduct data entry and rework, analyzing and identifying trends as well as completing reports daily.


Required Qualifications:

  • An education level of at least a high school diploma or GED OR 10 years of equivalent working experience.
  • 1 year of experience in an office setting environment using the telephone and computer as the primary instruments to perform job duties
  • 1 year of healthcare claims processing experience
  • Familiarity with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications.
  • Basic knowledge level of Microsoft Office including Word, Excel, and PowerPoint (create/edit/send/save).
  • Successful completion of the UnitedHealth Group new hire training and demonstrated proficiency required.


Preferred Experience:

  • 2+ years of healthcare claims processing experience
Telecommute Requirements:

  • Reside within the state of New York
  • Must have a location/workspace in your home that is separate from non-workspace areas and can be secured to maintain PHI or PI.
  • Must be willing to provide your physical address for verification that you live in a location that can receive UHG approved high speed internet connection.  This will be verified before an offer is extended.
  • If hired, must agree to remain in current location for at least 6 months after hire date.
  • Ability to complete, have notarized and submit via email or fax, the I9 form proving your eligibility to work in the US within 3 days of your hire date.

Soft Skills:

  • Ability to set up your work station which includes hooking up your computer and installing necessary applications.
  • Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product.
  • Strong written communication skills including grammatical composition and spelling.
  • Consistent attendance with ability to meet work schedule including the required training period.



UnitedHealth Group is a team of more than 260,000 people who are building career success through commitment, compassion and a desire to make a difference. Join us. Learn more about how you can start doing your life's best work.SM

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SM


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.


Key words:  claims, medical claims, healthcare claims, claims processing, claims processor; office, UnitedHealth Group, UnitedHealthcare,  training class, customer service representative, customer service, CSR, Data Entry, appeals, dispute resolution, phone support

Job ID: 2551_820337_1
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