POSITION DESCRIPTION

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 6 leader.

PRIMARY RESPONSIBILITIES:

• Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims
• Authorize appropriate payment or refer claims to investigators for further review
• Analyze and identify trends and provides reports as necessary
• Consistently meet established productivity, schedule adherence, and quality standards
• Provide excellent customer service
• Analyze and adjudicate claims to ensure accurate payment
• Meet Department Quality and Accuracy Standards.
• Interfaces with other departments to obtain necessary information required for resolution of claims
• Advise management of any claim issues or inappropriate and/or incorrect billing

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)
• 1+ years of experience in the following areas (Processing medical claims; knowledge of State and Federal regulations; Knowledge of HMO)
• Working knowledge of the following:
  • CPT / HCPCS
  • Rev Codes
  • ICD 9/10 coding and medical terminology within managed care industry
  • Standard claim forms and physician billing coding
  • Reading / interpreting benefit contracts & standard reference materials (PDR, RVS, CPT, and ICD 9/10)
  • Coordination of benefits
• Experience with Excel, Word, and Outlook (Ability to create, edit, copy, send and save correspondence and spreadsheets)

PREFERRED QUALIFICATIONS:

• Knowledge of current claims adjudication processes
• Knowledge of EZ Cap Systems
• Knowledge of Encoder pricing software (or similar in nature)
• Ability to effectively interpret and apply Policies & Procedures
• Intermediate proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications

SOFT SKILLS:

• Strong communication skills with strong analytical and problem solving skills
• Ability to self - manage in a fast - paced, detail - oriented environment with minimal supervision
• Ability to multi - task, this includes ability to understand multiple products and multiple levels of benefits within each product

Making claims a positive experience for our members can drive your sense of impact and purpose. Join us as we improve the lives of millions. Learn more about how you can start doing YOUR LIFE'S BEST WORK.(SM) OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians. Monarch HealthCare®, is led by doctors who are committed to offering patients the most extensive choices and access to Orange County's leading physicians, hospitals, labs and urgent care centers. This allows patients to get the perfect care in support of their good health. Monarch HealthCare's independent, private-practice physicians are part of a coordinated network that works together to promote excellence in patient care. Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment

A Fortune 6 company, we're focused on helping people live healthier lives while making the health system work better for everyone. Here, we seek to empower people with the information, guidance and tools to make personal health choices. We work harder and we aim higher. We expect more from ourselves and each other. And, at the end of the day, we’re doing a lot of good for more than 142 million people worldwide.