Claims Representative

This position is onsite at our office located at 3131 Camino Del Rio North, Suite 700, San Diego, CA, 92108.

About the role

This is a challenging role that requires the ability to thoroughly review, analyze, and research complex healthcare claims 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, supporting timely processing of members' claims.

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, comprehensive benefits, and career development opportunities.

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
• Other duties as assigned

Requirements

• High School Diploma / GED or equivalent work experience
• Must be 18 years of age or older
• 1+ years of experience in a related environment (e.g., office, administrative, clerical, customer service), using phones and computers as primary job tools
• 1+ years of experience using Microsoft Office applications
• 1+ years of experience with processing (reviewing, researching, adjudicating, and entering claims) medical or mental health claims
• Experience using computers and Windows-based applications, including the ability to learn new and complex computer system applications
• Ability to work onsite at 3131 Camino Del Rio North, Suite 700, San Diego, CA, 92108
• Ability to work full-time (40 hours/week) Monday - Friday, 8:00 AM - 5:00 PM PST, with occasional overtime as needed

Skills

• Ability to work independently and prioritize tasks
• Strong work ethic, independence, and dependability
• Excellent time management, organizational, and prioritization skills
• Ability to multitask
• Effective interpersonal, influence, collaboration, and listening skills
• Drive for results individually and in a team setting

Benefits

In addition to your salary, we offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements).

Pay

The hourly pay for this role ranges from $18 - $32 per hour based on full-time employment, depending on several factors including local labor markets, education, work experience, and certifications. We comply with all minimum wage laws as applicable.

Schedule

• Full-time (40 hours/week), Monday - Friday
• 8-hour shift during normal business hours: 8:00 AM - 5:00 PM PST
• Occasional overtime may be required
• Up to 90 days of onsite on-the-job training aligned to your schedule