This is an opportunity that's all about where you've been. Your experience. Your potential. Your skills. Because on the team at UnitedHealth Group, your potential and your impact can be career changing. No company has put together better teams of passionate, energetic and all out brilliant Claims Representatives. This is where you come in. We'll look for your experience and expertise to help keep our service levels and accuracy extremely high. We'll also look for your ideas on how to constantly evolve our claims processes. We'll back you with the great training, support and opportunities you'd expect from a Fortune 6 leader.
To process the medical claims of AppleCare’s IPA clients pursuant to designated production quotas for accuracy and productivity benchmarks. Our production quotas are a minimum of 175 IPA claims per day. **Please note that this is not a Billing position, but an actual Claims Examiner position.
- Batch and prioritize a minimum of 175 IPA claims processing per day utilizing the company’s in - house claims processing system
- Verify patient’s accounts for eligibility and benefits
- Process complex claims that have been accepted for payment
- Request and follow - up on additional information as needed for incomplete claims
- Complete all steps above within designated timeframes (production quotas) and notify management if claims cannot be processed within the designated time frame
- Assemble denial letter background information and generate denial letters
- Read, interpret and summarize medical contracts/division of responsibility before allowance of payments
- Identify claims that are not our financial risk and forward to appropriate entity for payment
- Review claims that are pending and follows through for payment in a timely manner
- Works with various fee schedules (i.e., CMS, Medical)
- Treat peers, superiors, subordinates clients and vendors with fairness, courtesy and professionalism and contribute to the overall positive work environment of the department
- Complete other production projects as assigned
- High school graduate
- Requires 3+ years experience working as an actual “Claims Examiner” in a Managed Care environment (Not as a Billing Clerk working on claims).
- 3 years of experience working with various fee schedules (i.e., CMS, Medical, etc.)
- Strong proficiency with computer and Windows PC applications, which includes the ability to learn new computer system applications
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.(sm)
AppleCare Medical Management Group was incorporated in 2003. Over the last 17 years, the multispecialty medical group of independent practices has expanded into new
communities, contracted with more hospitals and health plans, and added over 50 new doctors - but the mission has remained the same. Today, AppleCare Medical Management is comprised of hundreds of board-certified private-practice, independent physicians. Collectively, our physicians have been serving the Southeast area of Los Angeles and Northern Orange County for decades, providing their medical expertise and passion to improving the health of our communities.
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.
Job Keywords: Medical Claims Examiner, La Palma, California, CA, IPA, Managed Care, professional claims, denial process, compliance, healthplans, medical claims, CMS, DHMC
Medicare Part D