You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.Processing of medical claims including verification, adjudication and accuracy. Ensuring claims comply with regulatory standards, company policy, and guidelines.This position is full time, Monday - Friday. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8:00 am - 5:00 pm PST (can start as early as 6:00 am PST).We offer 2 - 3 weeks of paid training. The hours during training will be 8:00 am - 5:00 pm PST from Monday - Friday.All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.Primary Responsibilities:
Accurately processing of professional claims.
Responsible for editing and adjusting of EDI claims.
Analyze and adjudicate claims to ensure accurate payment
Interpret Fee for Service (FFS) and capitated provider contracts
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
Other duties assigned by management.
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
Must be 18 years of age OR older
2+ years of experience as a Medical Claims Examiner
1+ years of experience with professional claims processing
Working knowledge of Medical Terminology, ICD10, CPT4, CMS1500 forms
Medical Insurance Industry processing experience
Data Entry skills
Proficiency with Microsoft Office applications, to include Microsoft Word, Microsoft Excel, Microsoft Outlook, etc.
Experience in contract interpretation
Prior Medicare, HMO experience
Ability to work any shift between the hours of 8:00 AM - 5:00 PM PST (can start as early as 6:00 am PST)
Telecommuting Requirements:
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
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington, Rhode Island, OR Washington, D.C. Residents Only: The hourly range for this is $16.54 - $32.55 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.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 .#RPO