Claims Adjuster

About the role

This position is National Remote. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. 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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Schedule

• 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 8:00 am - 5:00 pm
• It may be necessary, given the business need, to work occasional overtime
• We offer 8 weeks of on-the-job training. The hours of training will be aligned with your schedule

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
• 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

Required Qualifications

• High School Diploma / GED OR equivalent work experience
• Must be 18 years of age OR older
• 1+ years of experience processing medical, dental, prescription or mental health claims
• 1+ years of experience processing claims using Facets
• 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
• Facets experience
• Proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
• Ability to work 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 8:00 am - 5:00 pm. It may be necessary, given the business need, to work occasional overtime

Preferred Qualifications

• Experience using EnterpriseNow

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 (UHG requires a wired internet connection: cable, DSL or fiber internet service with Minimum speed standard of 25 Mb download/10-15 Mb upload. Wireless services such as satellite, hot spot, line of sight antenna cannot be used for telecommuting.)
• All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay

The hourly pay for this role will range from $18.00 to $32.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Benefits

In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives.