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UnitedHealth Group Senior Claims Representative - Work from Home in Irvine, California

If you are located in the California area, you will have the flexibility to telecommute (work from home) as you take on some tough challenges.

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.SM

This is an opportunity that’s all about where you’ve been. Your experience. Your potential. Your skills. Because on the team at UnitedHealth Group , your potential and your impact can be career changing. No company has put together better teams of passionate, energetic and all out brilliant Claims Representatives. This is where you come in. We’ll look for your experience and expertise to help keep our service levels and accuracy extremely high. We’ll also look for your ideas on how to constantly evolve our claims processes. We’ll back you with the great training, support and opportunities you’d expect from a Fortune 10 leader.

This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work an 8-hour shift scheduled during our normal business hours of (7:30am - 4:00pm) Pacific Time. It may be necessary, given the business need, to work occasional overtime and weekends.

Training will be conducted virtually from your home.

This is a challenging role that takes an ability to thoroughly review, analyze and research complex health care 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 ensure timely processing of the member's claim.

Primary Responsibilities:

  • Assist with escalated claims to resolve complex issues for team members and internal customers

  • Support implementation of updates to the current procedures and assist with new system training/mentoring

  • Review guidelines as well as benefit plan documents and certificates to ensure proper benefits have been applied to each claim

  • Analyze and identify trends and provides reports as necessary

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 higher)

  • 3+ years of experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools

  • 1+ year experience processing medical, dental, prescription or mental health claims

  • Ability to work from 7:30 am - 4:00 pm Pacific Time, Monday through Friday with overtime, weekends and holidays as needed

  • Proficient in Microsoft Office including Microsoft Word (ability to open, create, edit, save, and send documents and other forms of documents), Microsoft Excel (ability to open, create, edit, save, and send spreadsheets) and Microsoft Outlook (ability to open, create, edit, save, and send emails)

  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders.

Telecommuting Requirements:

  • Must reside within the state of California

  • Dedicated work area established that is separated from other living areas that provides information privacy

  • Ability to keep all company sensitive documents secure (if applicable)

  • Residing in a location that can receive a high-speed internet connection (additional information on UnitedHealth Group approved internet providers and restrictions will be provided)

UnitedHealth Group is an essential business. The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. At this time, 90% of our non-clinical workforce transitioned to a work at home (remote) status. We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us. You can learn more about all we are doing to fight COVID-19 and support impacted communities at:

https://www.unitedhealthgroup.com/newsroom/addressing-covid.html

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM

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.

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