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Claim Analysis and Remediation Specialist - National Remote

Company: UnitedHealth Group
Location: Las Vegas
Posted on: November 26, 2022

Job Description:

You'll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. Energize your career with one of Healthcare's fastest growing companies. You dream of a great career with a great company - where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it's a dream that definitely can come true. Already one of the world's leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up. This opportunity is with one of our most exciting business areas: Optum - a growing part of our family of companies that make UnitedHealth Group a Fortune 5 leader. Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance. This position is full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 6:00am - 6:00pm CST. It may be necessary, given the business need, to work occasional overtime. All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. Primary Responsibilities:

  • Work independently while meeting appropriate deadlines consistently
  • Work with minimal guidance; seeks guidance on complex tasks
  • Act as a resource for others- primarily within the department, but also representing Behavioral Health Claim Operations across the enterprise
  • Coordinate own activities, work is self -directed and not prescribed
  • Plan, prioritize, organize and complete work to meet established objectives
  • Identify and resolve claim basic operational problems using defined processes, expertise and judgment
  • Investigate claim issues as identified and communicate resolution to internal customers
  • Identify root cause of issues
  • Development and documentation processes for accurate and efficient claim payment
  • Anticipate customer needs and proactively identifies solutions
  • Call upon others for assistance outside scope and with large, complex issues
  • Refer misdirected issues to non-claim teams
  • Provide expertise and customer service support to internal & external customers
  • Communicate research findings to applicable stakeholders
  • Review assigned CPEWS, Adjustment Trends, Denial Trends alerts in an accurate and timely manner and acting as appropriate
  • Apply knowledge / skills to identify and remediate straightforward claim issues
  • Other duties as assigned 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)
    • Ability to work 8-hour shift between hours of 6:00am - 6:00pm CST
    • Intermediate knowledge Microsoft Office: Word (create and edit correspondence)
    • Intermediate knowledge Microsoft Office: Excel (ability to create, edit, and sort spreadsheets, basic analytical formulas (vlookup, if
    • Intermediate knowledge Microsoft Office: Outlook (email and calendar management)
    • Intermediate knowledge Microsoft Office: PowerPoint (ability to create and edit slides)
    • Knowledge of the healthcare industry (e.g., billing practices, terminology, legal/regulatory requirements, coding standards, healthcare reform)
    • Identify and interpret applicable provider contract information (e.g., in-network vs. out-of-network, contracted rates, shared savings)
    • Knowledge of how to utilize and navigate applicable claims processing systems, platforms and databases (Must have CSP Facets or OBH Facets) Preferred Qualifications:
      • Associate's Degree (or higher)
      • 2+ years of claim adjustment experience
      • 1+ years of UNET or Cosmos experience
      • Knowledge of how to use and navigate NDB
      • Identify and interpret applicable provider contract information (e.g., in-network vs. out-of-network, contracted rates, shared savings) 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:
          • Demonstrated knowledge of company mission and values
          • Comfort with tight deadlines and acting with a sense of urgency
          • Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product
          • Demonstrated success using time and resources effectively, including thinking through the best sequence of steps, prioritizing and aligning work tasks, and seeking guidance when needed 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 with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So, when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work. SM Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $21.68 to $38.56. The salary range for Connecticut / Nevada residents is $23.94 to $42.40. 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: UnitedHealth Group, Las Vegas , Claim Analysis and Remediation Specialist - National Remote, Other , Las Vegas, Nevada

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