Remote Clinical Claims Coordinator

QuickCruit, Inc.; Dallas, Northern (TX, KY); Hybrid; USD 42,000 - 56,000; Full time

Job summary

UnitedHealth Group is seeking a Clinical Administrative Coordinator for a National Remote role based in the United States. The position will involve the initial triage of clinical claim reviews, administrative preparation for nurse review, and collaboration with claims operations and clinical teams.

Flexible to work any shift during 8:00 am - 4:30 pm, with occasional overtime and paid training weeks. The role requires verifying claim information, member eligibility, and prior authorization

Responsibilities

• Access claims information in the claims payment system.
• Determine if Medical Claim Review is required for the service using department resources (e.g., job aids, prior-authorization lists, MCR Code List)
• Verify member eligibility
• Determine health plan and network
• Verify prior authorization and/or inpatient utilization review information in claims payment system
• Create and send letters to providers as directed by nurses
• Follow standard procedures to complete work, including departmental job aids and policies
• Learn computer system and process changes and updates to incorporate into daily work

Job description

UnitedHealth Group is seeking a Clinical Administrative Coordinator for a National Remote role based in the United States. The position will involve the initial triage of clinical claim reviews, administrative preparation for nurse review, and collaboration with claims operations and clinical teams.

Flexible to work any shift during 8:00 am - 4:30 pm, with occasional overtime and paid training weeks. The role requires verifying claim information, member eligibility, and prior authorization