IDR Claims Specialist - Kelsey Seybold -Remote

Optum; Pearland (TX); On-site; USD 28,000 - 50,000; Full time

Job summary

Kelsey-Seybold Clinic, part of the Optum family, is seeking an Independent Dispute Resolution (IDR) Claims Specialist in Texas. You will analyze and organize claims documentation for submission to the Texas Department of Insurance and Federal IDR entities to support dispute resolution.

The role requires strong claims adjudication experience, proficiency with Microsoft Office, and the ability to coordinate with Claims, Provider Disputes, and external stakeholders while maintaining HIPAA

Qualifications

• 2+ years of claims adjudication experience in an HMO, PPO, or TPA environment.
• Experience researching, reviewing, and processing medical claims.
• Proficiency with Microsoft Office Suite (Excel, Word, Outlook) and spreadsheet tracking.
• Excellent written and verbal communication skills.
• Ability to interpret claim data, supporting documentation, and payer requirements.
• Demonstrated attention to detail with accuracy and data integrity.
• Strong time-management and organizational skills; ability to work independently.
• Professionalism, ethical judgment, and HIPAA adherence.
• Ability to collaborate with cross-functional teams and external stakeholders.

Responsibilities

• Analyze, organize, and prepare claims documentation for submission to the Texas Department of Insurance and Federal IDR entities.
• Support resolution of out-of-network billing disputes with accurate submission and follow-through.
• Perform claim adjustments based on final determinations from negotiation, mediation, or arbitration.

Skills

2+ years of claims adjudication

Researching medical claims

MS Office & spreadsheet tracking

Excellent written and verbal comms

Interpret claim data & payer rules

Attention to detail

Time management & organization

Professionalism & HIPAA compliance

Cross-functional collaboration

Education

High School Diploma or GED

Tools

EPIC

Centricity

Smartsheets

Job description

Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together.

The Independent Dispute Resolution (IDR) Claims Specialist is responsible for analyzing, organizing, and preparing claims documentation for submission to the Texas Department of Insurance (TDI) and Federal Independent Dispute Resolution entities to support the resolution of out-of-network billing disputes. This role ensures accurate tracking, submission, and follow-through of IDR cases while maintaining compliance with regulatory, payer, and internal requirements. The position also performs claim adjustments based on final determinations resulting from negotiation, mediation, or arbitration. The Specialist works collaboratively with Claims, Provider Disputes, and external stakeholders while maintaining strict confidentiality and data integrity standards.

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 or GED
• 2+ years of claims adjudication experience in an HMO, PPO, or TPA environment
• Experience researching, reviewing, and processing medical claims
• Proficiency with Microsoft Office Suite (Excel, Word, Outlook) and spreadsheet tracking
• Proven excellent written and verbal communication skill
• Proven ability to interpret claim data, supporting documentation, and payer requirements
• Demonstrated solid attention to detail with the ability to ensure accuracy and completeness of work
• Demonstrated solid time-management and organizational skills with the ability to work independently
• Demonstrated professionalism, ethical judgment, and adherence to HIPAA requirements
• Demonstrated ability to collaborate effectively with cross-functional teams and external stakeholders

Preferred Qualifications

• Experience supporting IDR, arbitration, mediation, or regulatory dispute processes
• Experience with claims systems such as EPIC, Centricity, or similar platforms
• Familiarity with managed care or Medicare Advantage claims environments
• Familiarity with Smartsheets or comparable workflow tools

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 $20 - $36 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.

OptumCare 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.

OptumCare is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.