15 days old

LHI - Claims Resolution Specialist I - La Crosse, WI

La Crosse, WI 54601
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  • Job Code
    864062
At Optum, the mission is clear:  Help people live healthier lives and help make the health system work better for everyone

LHI is one of 4 businesses under OptumServe. OptumServe provides health care services and proven expertise to help federal government agencies modernize the U.S. health system and improve the health and well - being of Americans. By joining OptumServe you are part of the family of companies that make UnitedHealth Group a leader across most major segments in the U.S. health care system.

LHI was founded in 1999 and acquired by Optum in 2011, LHI specializes in creating and managing health care programs through on - location services, patient - specific in - clinic appointments, tele - health assessments, or any combination based on customer need. LHI's customizable solutions serve the diverse needs of commercial customers, as well as federal and state agencies, including the U.S. Departments of Defense, Veterans Affairs, and Health and Human Services.

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Ready for a new path? Start doing your life's best work.SM 
 
The LHI - Claims Resolution Specialist I will process dental claims and coordinate claims inquiries for certified Veterans of the VA Community Care Network program throughout the United States. Data entry of dental claims data.  Educate and inform Providers of program coverage and limitations for claims within contract requirements.  Respond to cases involving Veteran's claims with Customer Service staff.  Use critical thinking, research and problem - solving skills to navigate through the complexities of a Veteran's episode of care requirements and their respective dental claims while maintaining coverage within the program guidelines

Primary Responsibilities:
  • Maintain an ongoing responsibility for assigned claims inquiries which entails assessment, education and coordination for members / health care providers throughout the United States via telephone while keeping a detailed record within the internal database. Establish and maintain positive relationships with members, providers and our claims contractors
  • Manage inbound and outbound calls from providers and members to resolve claims issues
  • Request and manage medical records to help determine potential program coverage and communicate results to the members
  • Completion of system generated tasks, including documenting all results as required
  • Prepare comprehensive reviews and summaries for claims appeals
  • Point of contact for internal departments to answer questions relative to member claims
  • Work with the leadership team to resolve issues as needed
  • Able to handle emotionally charged phone calls and ability to deliver unfavorable claims outcomes
  • Ability to communicate complex program criteria into easily understood summaries in both oral and written communication
  • Validation of claim coverage in relation to program guidelines
  • Compete activities and reporting as required by the fraud, waste and abuse plan

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.

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Posted: 2020-03-20 Expires: 2020-04-20

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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LHI - Claims Resolution Specialist I - La Crosse, WI

UnitedHealth Group
La Crosse, WI 54601

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