Arbitration Claims Specialist

UnitedHealthcare; Dallas (TX); Remote; USD 33,000 - 59,000; Full time

Benefits offered by this job

Comprehensive benefits package

Equity stock purchase

401k contribution

Job summary

UnitedHealth Group is seeking an Arbitration Claims Specialist to support the IDR team in ensuring compliance with No Surprises Act and state surprise billing laws. This full-time remote role handles dispute review and arbitration briefs, with flexibility to work 8-hour shifts during business hours.

You will analyze EOBs and claims data, respond to inquiries, and resolve issues in a fast-paced environment, contributing to accurate dispute outcomes while maintaining HIPAA compliance and

Qualifications

• High School Diploma / GED OR equivalent work experience
• Must be 18 years of age OR older
• 1+ years of experience preparing written summaries, case reviews, reports, or briefs in a regulated, compliance driven, or legal adjacent environment
• 1+ years of experience reviewing and interpreting claims data, Explanation of Benefits, and supporting documentation to identify issues and determine appropriate next steps
• Experience ensuring compliance with HIPAA privacy and security regulations
• Ability to work full-time between 8:00 am - 5:00 pm local time, including the flexibility to work occasional overtime given the business need

Responsibilities

• Prepare arbitration briefs
• Respond to inquiries from CMS, arbiters, providers, clients, and ClearHealth management
• Identify issues, analyze EOBs and claim information, apply critical thinking skills to formulate plan of action, and resolve issues independently
• Triage complex issues to management
• Manage multiple priorities in a time sensitive manner
• Work in fast-paced, high-volume environment with quick turnaround time

Education

High School Diploma / GED OR equivalent work experience

Job description

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Arbitration Claims Specialist (2390606)

Arbitration Claims Specialist

Job Number:

2390606

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.

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.

This role supports ClearHealth Strategies’ Independent Dispute Resolution (IDR) team in a quasi-legal process focused on dispute review, eligibility analysis, and preparing arbitration briefs to ensure compliance with the federal No Surprises Act and state surprise billing laws.

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 depending on the local time zone. It may be necessary, given the business need, to work occasional overtime.

Primary Responsibilities:

• Prepare arbitration briefs
• Respond to inquiries from CMS, arbiters, providers, clients, and ClearHealth management
• Identify issues, analyze EOBs and claim information, apply critical thinking skills to formulate plan of action, and resolve issues independently
• Triage complex issues to management
• Manage multiple priorities in a time sensitive manner
• Work in fast-paced, high-volume environment with quick turnaround time

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 / GED OR equivalent work experience
• Must be 18 years of age OR older
• 1+ years of experience preparing written summaries, case reviews, reports, or briefs in a regulated, compliance driven, or legal adjacent environment
• 1+ years of experience reviewing and interpreting claims data, Explanation of Benefits, and supporting documentation to identify issues and determine appropriate next steps
• Experience ensuring compliance with HIPAA privacy and security regulations
• Ability to work full-time between 8:00 am - 5:00 pm local time, including the flexibility to work occasional overtime given the business need

Preferred Qualifications:

• 1+ years of experience working with the federal No Surprises Act (NSA) and/or state surprise billing disputes
• Experience supporting or working within personal injury litigation
• Knowledge of the medical claims process

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

All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. 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. The salary for this role will range from $24- $43 hourly based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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

Other Locations

US-CT-Hartford, US-MN-Minneapolis, US-AZ-Phoenix, US-FL-Tampa

UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or accommodation for any part of the application process, please call 1-866-566-8715 to be connected to Recruitment Services. Recruitment Services hours of operation are 7 a.m. to 7 p.m. CT, Monday through Friday.

UnitedHealth Group is a registered service mark of UnitedHealth Group, Inc. The UnitedHealth Group name with the dimensional logo, as well as the dimensional logo alone, are both service marks for the UnitedHealth Group, Inc.

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.