Claims Representative

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.

Claims Representative within Manual Claims department focusing on DMRs and provider claims across all lines of business. This position focuses on both claims processing efficiency and accuracy to meet compliance. Impact of lack of staff for this role could create PG penalties or IREs and impact company STAR ratings, leading to financial penalties. Lettering delays, member experience, and payment delays could also be impacted. Skills needed include understanding claims processing and the RxCLAIM and web view applications. This role is unable to be absorbed due to the compliance nature of the role including on-shore restrictions and Medicare Compliance risks. This is a non-discretionary request based on claims volume and available resource capacity to meet existing performance guarantees. Through planned reduction, we are currently operating above capacity due to surges in PTO Needs, FMLA and to support ongoing volume to continue adherence to client commitments.

This position is full-time (40 hours/week) with flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:30 am – 4:00 pm PST, Monday – Friday. Occasional overtime and holidays may be required, given the business need.

We offer 4 - 8 weeks of on-the-job training conducted virtually from your home. The hours during training will be an 8-hour shift between 7:30 am to 4:00 pm PST, Monday - Friday.

If you are located within the Pacific Standard Time Zone, you will have the flexibility to work remotely as you take on some tough challenges.

Primary Responsibilities:

• Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing, and adjusting claims.
• Analyze and identify trends and provide reports as necessary.
• Consistently meet established productivity, schedule adherence, and quality standards.

You’ll be rewarded and recognized for your performance in an environment that will challenge you and provide development for other roles you may be interested in.

Required Qualifications:

• High School Diploma / GED
• Must be 18 years of age OR Older
• 3+ years of experience in an office, healthcare, or pharmacy environment
• Familiarity with computer and Windows PC applications
• Ability to work any of our 8-hour shift schedules during normal business hours.

Preferred Qualifications:

• 1+ years of experience in processing claims
• 1+ years of Medicare knowledge

Telecommuting Requirements:

• Reside within Pacific Standard Time Zone
• Ability to keep all company sensitive documents secure
• Required to have a dedicated work area established that provides information privacy
• Must live in a location that can receive a high-speed internet connection

Soft Skills:

• Critical thinking skills
• Ability to work independently and in a team environment
• Flexibility and the ability to change between different tasks as needed
• High personal accountability
• Professional communication skills

Physical and Work Environment:

• Extended periods of sitting at a computer and use of hands / fingers across keyboard or mouse
• Office environment

California, Nevada, Washington Residents Only: The hourly range for this role is $16.54 to $32.55 per hour. Pay is based on several factors including 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).