Claims Adjustment Representative - Remote

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Posted 13 days ago United States Salary undisclosed
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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.

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.SM

The health care system is evolving at a rapid pace. Technology is driving new advances in how patient care is delivered and reimbursed. Now, E&I Claim Performance and Rework Operations of UnitedHealth group invites you to help us execute a more accurate and innovative approach to claims resolution. This is a very 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. Using multiple platforms, you'll also assist with pricing verification, prior authorizations, benefits, and coding. If your mission is to have a direct positive impact on the customer, join us and build your career with an industry leader.

This position is full-time (40 hours/week) Monday - Friday. Employees are required to work our normal business hours with 7:00am - 3:30pm training hours. It may be necessary, given the business need, to work occasional overtime or weekends.

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

Primary Responsibilities:

* Evaluate 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)
* Learn and leverage new systems and training resources to help apply claims processes/procedures
* Expert system navigation and computer skills
* Analyze trends and complete daily reports
* Provide expertise and complex claims support to customers
* Make determinations to authorize payment or refer claims to internal business partners for further review
* Apply an extensive understanding of claim intake and workflow
* Recall and leverage claim patterns, standards, and procedures to make determinations across a variety of claim scenarios
* Work independently
* Engage with customers as needed (i.e., phones, meetings, etc.) to resolve claims and communicate outcomes
* Thrive in an environment of intense innovation and change
* Act as a resource for others

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 equivalent work experience
* 1+ years of successful experience in a production environment, with computers as a primary job tool
* UNET platform claim experience
* Experience with computer and Windows PC applications, including expert keyboard and navigation skills, multiple monitors, macros, and interface applications

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

Soft Skills:

* Ability to quickly learn and apply new computer programs
* Ability to compose grammatically correct correspondence that translates medical and insurance expressions into simple terms that customers can easily understand

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible.

Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of healthcare. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work.SM

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $15.00 to $25.19. The salary range for Connecticut / Nevada residents is $15.77 to $27.79. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

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.

Keywords: Claims, Adjustments, Healthcare, medical, UNET, work at home, work from home, WAH, WFH, remote, telecommute, hiring immediately, #RPO