24 days old

Claims Processor - Ontario, CA - 917742

Ontario, CA 91764
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  • Job Code
    917742

Making claims a positive experience for our members can drive your sense of impact and purpose. Join us as we improve the lives of millions. Learn more about how you can start doing your life's best work.(sm)

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Primary Responsibilities:

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  • Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims
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  • Analyze and identify trends and provide reports as necessary
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  • Consistently meet established productivity, schedule adherence and quality standards
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  • Extensive work experience within own function
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  • Work is frequently completed without established procedures
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  • Works independently
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  • May act as a resource for others
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  • May coordinate others' activities.- Extensive work experience within own function
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This is a challenging role that takes an ability to thoroughly review, analyze and research complex healthcare claims in order to identify discrepancies, verify pricing, confirm prior authorizations and process them for payment. You'll need to be comfortable navigating across various computer systems to locate critical information. Attention to detail is critical to ensure accuracy which will support timely processing of the member's claim. Positions in this function are responsible for providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims. Authorizes the appropriate payment or refers claims to investigators for further review. Conducts data entry and re-work; analyzes and identifies trends and provides reports as necessary.

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Youll 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.

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Required Qualifications:

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  • High school diploma or GED OR equivalent years of work experience
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  • 1+ years of experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools
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  • Proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
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  • Customer service experience working with professionals face to face, via email and over the phone
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  • You will be asked to perform this role in an office setting or other company location
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  • Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained
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Preferred Qualifications:

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  • 1+ years ofexperience processing medical, dental, prescription or mental health claims
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  • Knowledge of ICD-10 and CPT codes
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Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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)

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OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCares support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

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Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

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OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment

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Job Keywords:claims, coding, Ontario, NAMM, CA, California, Optum, United Health Group, healthcare, customer service, medical

Posted: 2021-03-26 Expires: 2021-04-25

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

Sponsored by:
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Claims Processor - Ontario, CA - 917742

UnitedHealth Group
Ontario, CA 91764

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