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 to start Caring. Connecting. Growing together.
We are in search of a self-directed professional with a strong work ethic and the ability to thrive under pressure situations. If you want to work in a position that offers challenging work and a variety of problems to solve and troubleshoot, this might be the right role for you.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Accountable for ownership of provider claim projects in an end-to-end process, from initial communication, identification of claim payment issue, facilitation of resolution of claim payment issues and communication of outcome
Ability to educate provider on details of UHG reimbursement policies. etc., and related claim issues for the E&I Commercial Unet products
Must possess a strong working knowledge of the E&I Commercial Unet products with the ability to interpret and apply guidelines, regulations, and mandated benefits
Interact directly with market providers and internal office staff in the resolution of claim issues
Resolve complex provider claim issues; support fellow team members and provide feedback to Leadership as needed
Maintain ongoing communication throughout the project process
Research claims to determine accuracy and identify high level root cause of any claim payment issues
Ensure consistent quality service to UHGs customers
Meet or exceed all productivity, turnaround time, and quality assurance expectations and guidelines
Research complex issues while navigating multiple platforms and databases
Work with project contact to gather information, prepare and submit claims for reconsideration, if applicable. Ensure accurate project submission based on the identified root cause
Upon project completion by CRT, audit project results, send rebuttals as necessary
Prepare and send project results to project contact, conduct final project contact call to review project outcome and ensure satisfaction with project results
Maintain documentation of all project activities and communications within the CPM application
Serve as primary point of contact for project submitters in resolution of claims project issues
Maintain compliance with all Federal/State regulations and UHG policies
Collaborate with other business partners to gather data needed for resolution
Works all provider types
Manages complex or escalated global projects
Escalated and formal complaint high volume projects
Take ownership for self-development by actively engaging in CLL practices
A Typical Day in the Life
Perform root cause analysis on claim projects
Request and audit claim impact reports
Route impacted claims to the claim adjustment unit for re-processing
Perform backend audits to ensure claims were re-processed correctly
Communicate with internal and external business partners
Read and respond to emails
Complete training as required
Handle special projects assigned by manager
Make outbound calls to providers as required
Take ownership and follow through on outstanding issues
Serve as single point of contact for internal and external business partners for claim projects
Attend required calls
Skills You Will Gain
Communication skills
Deeper understanding of business partners operations
Enhanced understanding of claim processing procedures
Big picture view of the organization
Ability to influence without authority
Broader network of internal contacts
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)
2+ years of experience with applicable claims platform (Cirrus)
2+ years of experience with UHG processes, systems, and products for the platform you are applying for
2+ years of experience with physician, facility, and ancillary claims
2+ years of prior experience working directly with customers
Intermediate level of proficiency with MS Office (Word, Excel, Outlook)
Must be presently employed within UHC Provider Operations
Preferred Qualifications:
Undergraduate degree
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
For more information on our Internal Job Posting Policy, .
The salary range for this role is $23.70 to $46.35 per hour based on full-time employment. 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.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
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, #GREEN
UnitedHealth Group
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