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Claims Representative - Remote in West Virginia at UnitedHealth Group

Claims Representative - Remote in West Virginia

UnitedHealth Group Work From Home, PA (Remote) Full-Time

If you are located within West Virginia, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges.

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life’s best work.SM

Even if you have no prior experience, we have training classes starting soon to help you build the successful career that you want - apply today! We provide the support and structure, you provide the interest and motivation.

It’s that time, isn’t it? You’re ready for the next step forward and an opportunity to build on your skills. And it just so happens that there’s never been a better time to get on the team at UnitedHealth Group. We’ve built one of the world’s most effective and respected claims processing teams. And that’s where you come in. We’ll look to you to maintain our reputation for service, accuracy and providing a positive claims experience. We’ll back you with the great training, support and opportunities you’d expect from a Fortune 10 company leader.

This position is full-time (40 hours/week). Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am - 8:00pm CST. It may be necessary, given the business need, to work occasional overtime. 

We offer 7 weeks of claims training. The hours during training will be 8:00 am to 4:30 pm CST.

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

Primary Responsibilities:

  • Research, identify and obtain data/information needed to help process claims or resolve claims issues (e.g., verify pricing, prior authorizations, applicable benefits)
  • Ensure that proper benefits are applied to every claim
  • Apply knowledge of customer service requirements to process claims appropriately (e.g., Service Level Agreements, performance guarantees)
  • Identify and apply knowledge of new plans/customers to process their claims appropriately
  • Identify and resolve claims processing errors/issues and trends, as needed (e.g., related to system configuration, network, eligibility, data accuracy, vendor-related, provider)
  • Resolve or address new or unusual claims errors/issues as they arise, applying appropriate knowledge or prior experience
  • Communicate and collaborate with external stakeholders (e.g., members, family members, providers, vendors) to resolve claims errors/issues, using clear, simple language to ensure understanding
  • Collaborate with internal business partners to resolve claims errors/issues (e.g., Subject Matter Experts, Network Management, 
  • IT/systems staff, Compliance, vendor management teams, contract teams)
  • Document and communicate status of claims/investigations to stakeholders as needed, adhering to reporting requirements (e.g., status letters/reports)
  • Achieve applicable performance metrics (e.g., productivity, quality, TAT
  • Use appropriate systems/platforms/applications to process claims
  • Navigate systems tools and screens efficiently and effectively (e.g., keyboard skills, macros, shortcuts)
  • Use appropriate documentation, reference materials and/or websites to ensure that claims are processed accurately and efficiently (e.g., policy/procedure manuals, knowledge libraries, bulletins, training materials, databases, SharePoint sites, data warehouses)
  • Learn and use new systems/applications/resources as needed

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:

  • High School Diploma / GED (or higher) OR 10+ years of equivalent work experience
  • 1+ years customer service experience in an office or professional setting
  • Ability to successfully complete the training classes and demonstrate proficiency of the material
  • Ability to work any of our 8-hour shift schedules during our normal business hours of 7:00am - 8:00pm CST. It may be necessary, given the business need, to work occasional overtime. 

Preferred Qualifications:

  • Prior experience utilizing multiple systems/platforms while on a call with a member
  • Familiarity with medical terminology, health plan documents, or benefit plan design

Telecommuting Requirements:

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

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for 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.


Recommended Skills

  • Claim Processing
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