Claims Representative

RXinsider LTD.; San Diego (CA); On-site; USD 51,577,000 - 91,693,000; Full time

Job summary

UnitedHealth Group in San Diego is seeking a qualified Onsite Claims Reviewer to thoroughly review, analyze, and research complex healthcare claims. The role requires processing claims, verifying pricing, and ensuring timely payment with accurate data across multiple systems.

You will work a full-time schedule (40 hours/week), with an 8-hour shift between 8:00am and 5:00pm PST, and occasional overtime as needed.

Qualifications

• High School Diploma or GED or equivalent work experience.
• Must be 18 years of age or older.
• 1+ years of experience in a related environment (office, administrative, clerical, customer service, etc.).
• 1+ years of experience using Microsoft Office applications.
• 1+ years of experience with processing medical or mental health claims.

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.

Skills

Independent work

Time management

Organizational skills

Multitasking

Interpersonal skills

Collaboration

Education

High School Diploma or GED

Tools

Microsoft Office

Job description

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

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.

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.

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

We offer up to 90 days of onsite on the job training aligned to 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
• Other duties as assigned

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 in a related environment (i.e., office, administrative, clerical, customer service, etc.), 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, which includes the ability to learn new and complex computer system applications
• Ability to work onsite. Our office is located at 3131 Camino Del Rio North, Suite 700, San Diego, CA, 92108
• Ability to work full-time (40 hours/week) Monday - Friday. Employees are required to work an 8-hour shift schedule during our normal business hours of 8:00am - 5:00pm PST. It may be necessary, given the business need, to work 0ccasional overtime.

Soft Skills

• Ability to work independently and prioritize tasks
• Display strong work ethic, independence, and dependability
• Exhibit excellent time management, organizational, and prioritization skills
• Demonstrate the ability to multitask
• Possess effective interpersonal, influence, collaboration, and listening skills
• Drive for results individually and in a team setting

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 hourly pay for this role will range from $18 - $32 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

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.