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  • Tampa, FL

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Claims Adjustment Representative - US Telecommute

UnitedHealth Group • Tampa, FL

Posted 15 days ago

Job Snapshot

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

Job Competition

75+

Applicants

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Job Description

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. 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.


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


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). This role is open to telecommute / work at home or to work onsite at any of our US office locations.

There are several steps in our hiring process. Please make sure that you have filled out all required sections of your employment application.  Once you submit your completed application, you will receive an e-mail with information regarding next steps including any pre-employment assessment(s) that are required.  Both your application and any required assessment(s) need to be completed before we can consider you for employment so the sooner you complete these two steps, the sooner you will hear from us. To learn more, go to: http://uhg.hr/OurApplicationProcess

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 

  • 1+ year of experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools
  • High school diploma or GED OR equivalent work experience
  • Demonstrated ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills and learning new computer programs
  • Ability to compose grammatically correct correspondence that translates medical and insurance expressions into simple terms that members can easily understand

Telecommuting Requirements
  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
  • Ability to keep all company sensitive documents secure (if applicable)
  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

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_801988_2
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