1+ months

Healthcare Claims Resolution Specialist - Remote within Alabama - 899322

Birmingham, AL 35203 Work Remotely
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  • Job Code
    899322
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If you are located in Alabama, you will have the flexibility to telecommute* as you take on some tough challenges. Imagine this. Everyday, in claims centers around the world,"UnitedHealth Group is processing and"resolving payment information for millions of transactions. Would you think we"have some great technology? Would you think we know how to manage volume? You"would be right. No one's better. And no company has put together better teams"of passionate, energetic and all out brilliant Claims Representatives. This is where you come in. We'll look to"you to maintain our reputation for service, accuracy and a positive claims"experience. We'll back you with great training, support and opportunities.

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

This position is"responsible for negotiating specified types and"dollar amount of assigned claims/bills that are more complex on behalf of the"client to achieve maximum discount and savings from Equian reimbursement"determination.

The incumbent works"under general supervision to complete job responsibilities in applying a"fundamental knowledge of principles, practices and procedures related to the"negotiation of provider agreements. Work"is more complex and requires independent judgment within established"guidelines. More complex issues are"referred to higher levels. Incumbent may"mentor less experienced team members.

This position is full-time (40 hours/week) Monday - Friday."Employees are required to have flexibility to work any of our 8 hour shift"schedules during our normal business hours of (8:00am - 5:00pm). It may be"necessary, given the business need, to work occasional overtime.

Primary Responsibilities:

  • Foster and maintain provider relationships to"facilitate current and future negotiations.

  • Perform claim research and analysis to"provide support for appropriate savings.

  • Initiate provider telephone calls with"respect to proposals, overcome objections and apply effective telephone"negotiation skills to reach successful resolution on negotiated claims.

  • Address counter-offers received and present"proposal for resolution while adhering to client guidelines and department"goals.

  • Meet and maintain established departmental"performance metrics.

  • Manage high volume of claims in a queue; keep"current with all claim actions and meet client deadlines and any state specific"deadlines for working and closing claims.

  • Identify and seek opportunities to achieve"savings with previously challenging/unsuccessful providers.

  • Collaborate, coordinate, and communicate"across internal departments (i.e. Bill Review and Appeals).

This is a challenging role that takes an ability to"thoroughly review, analyze and research complex health care 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 impact the timely processing of the"member's claim.

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 or GED (or higher)

  • Minimum of (1) year of work experience in the healthcare industry (clinical OR provider billing provider collections)

  • Minimum of (1) year of experience with complex hospital and medical billing procedures and coding; cost of care applications and medical bill negotiation skills

  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders.

Preferred Qualifications:

  • 1+ year of experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools

  • 1+ year experience processing medical, dental, prescription or mental health claims

Telecommuting Requirements:
  • Reside within Alabama
  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
  • Ability to keep all company sensitive documents secure (if applicable)
  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
  • You will be required to adhere to UnitedHealth Group's US"Telecommuting Policy

Soft Skills:

  • Attention to detail to ensure accuracy including mathematical calculations
  • Strong communication (verbal and written), teamwork, negotiation and organizational skills.
  • Ability to analyze data and arrive at a logical conclusion.
  • Ability to identify issues and determine appropriate course of action for resolution
  • Ability to display professionalism by having a positive demeanor, proper telephone etiquette and use of proper language and tone
  • Ability to work with accuracy in a fast-paced environment
  • Ability to adjust/alter workflow to meet deadlines
  • Ability to work independently and handle confidential information
  • Ability to process detailed verbal and written instructions
  • Ability to mentor less experienced team members

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

UnitedHealth Group is working to create the health care system of tomorrow.

Already Fortune 6, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we're doing a lot of good.

Through our family of businesses and a lot of inspired individuals, we're building a high-performance health care system that works better for more people in more ways than ever. Now we're looking to reinforce our team with people who are decisive, brilliant - and built for speed.

Come to UnitedHealth Group, and share your ideas and your passion for doing more. We have roles that will fit your skills and knowledge. We have diverse opportunities that will fit your dreams.

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.


Key words: Healthcare, health care, Managed Care, Billing Representative, Billing, Collections, Claims, Customer Service, Medical Billing, hiring immediately

Posted: 2020-11-25 Expires: 2021-01-24

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.

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Healthcare Claims Resolution Specialist - Remote within Alabama - 899322

UnitedHealth Group
Birmingham, AL 35203

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