LTSS Claims Specialist — Remote in TN

UnitedHealthcare; Brentwood (TN); Remote; USD 60,000 - 107,000; Full time

Job summary

UnitedHealthcare is seeking a Claims Provider Service Advocate to support LTSS claims in a remote TN setting. The role focuses on investigating, recovering, and resolving claims issues, ensuring compliance with contractual terms and policies.

The ideal candidate brings strong analytical skills, attention to detail, and the ability to work independently across systems like CSP Facets. Travel up to 10% may be required for in-market meetings.

Qualifications

• 4+ years of experience in claims recovery and resolution.
• Intermediate level of proficiency in CSP Facets.
• Intermediate level of proficiency in Windows PC applications and the ability to learn new complex systems.
• Reside in Tennessee.
• Ability to travel to TN up to 10% for in-market team meetings as necessary.

Responsibilities

• Investigate and resolve LTSS claim issues and escalations with accuracy and urgency.
• Provide claims expertise and support to the LTSS Provider Services and Relations Team.
• Research and analyze claims trends; compile reports and share findings with leadership.
• Ensure adherence to reimbursement policies, contract terms, and state compliance requirements.
• Support recovery and resolution efforts for the health plan.
• Handle high-level provider escalations as needed.
• Facilitate and lead quarterly claims clinics with providers to identify areas for improvement and provide education.
• Work across multiple systems daily, including CSP Facets and related tools.

Skills

Analytical thinking

Attention to detail

Effective written and verbal

Project prioritization

Independent worker

Tools

CSP Facets

Windows PC applications

Job description

UnitedHealthcare is seeking a Claims Provider Service Advocate to support LTSS claims in a remote TN setting. The role focuses on investigating, recovering, and resolving claims issues, ensuring compliance with contractual terms and policies.

The ideal candidate brings strong analytical skills, attention to detail, and the ability to work independently across systems like CSP Facets. Travel up to 10% may be required for in-market meetings.