UnitedHealth Group
UMR, UnitedHealthcare’s third-party administrator (TPA) solution, is the nation’s largest TPA. When you work with UMR, what you do matters. It’s that simple . . . and it’s that rewarding.
In providing consumer – oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system. Opportunities are endless for your career development and advancement within UMR due to our record-breaking growth.
Regardless of your role at UMR, the support you feel all around you will enable you to do what you do with energy, quality, and confidence. So, take the first step in what is sure to be a fast – paced and highly diversified career.
In this role, you’ll be responsible for all aspects of quality assurance within the claims job family including conducting audits and providing feedback to reduce errors and improve processes and performance. Join us and build your career with an industry leader.
This position is a front line operations role that supports targeted review of fraud, waste, abuse and error through reviewing and identifying claims via the Financial and Clinical Surveillance dashboard as well as working through incoming referral requests This role includes sending both internal and external communication and identifies UMR customer claims targeted for both internal and external review.
This position is full – time (40 hours / week) Monday – Friday during our normal business hours between 7:00 AM to 5:00 PM CST. It may be necessary, given the business need, to work occasional overtime or weekends.
We offer weeks of on-the-job training. The hours during training will be 7:00am to 5:00pm, Monday – Friday in your time zone.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Provide claim and data analysis through a customized payment integrity fraud, waste, abuse and error web dashboard and reporting tool.
Detect, organize, and investigate complex types of fraudulent activity and decide the most effective and efficient method of investigation.
Evaluate referrals and information from multiple data sources to determine if further investigation is required.
Establish, triage, and manage inventory in a SharePoint setting.
Complete assigned investigations by securing needed information, reviewing medical documentation, and preparing informative reports which include documenting evidence.
Coordinate claim routing and processing for completed reviews.
Communicate case updates to internal customers, escalating when appropriate.
Perform other duties as assigned.
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 equivalent work experience
1+ years of experience analyzing and solving customer problems.
1+ year of medical claims processing experience using UMR’s Claims Processing System (UMR CPS/ Jacada). Please note, UMR is UnitedHealthcare’s third-party administrator (TPA) solution. You must be or have been an employee of UMR to have experience with the UMR claims processing system (UMR CPS/ Jacada).
Knowledge of medical claims billing (ICD-10 diagnoses, CPTs, and HCPCS codes)
Experience with complex claim processing and/or adjustments
Ability to create, edit, copy, send, and save documents, correspondence, and spreadsheets in Microsoft Excel, Microsoft Word, and Microsoft Outlook
Must be 18 years of age or older
Ability to work during our normal business hours between 7:00 AM to 5:00 PM CST. It may be necessary, given the business need, to work occasional overtime or weekends.
Preferred Qualifications:
Familiarity with resources such as EncoderPro, Knowledge Library, and UMR Policies and Procedures
Experience supporting projects.
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.
Soft Skills:
Ability to multi-task, this includes the ability to understand multiple products and multiple levels of benefits within each product.
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington, Rhode Island, OR Washington, D.C. Residents Only: The hourly range for this is $23.22 – $45.43 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.
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UnitedHealth Group
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