Senior Claims Examiner – San Antonio, TX or Telecommute

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm)

You’ll enjoy the flexibility to telecommute* from within the U.S. as you take on some tough challenges. 
 

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 provide reports as necessary
• 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

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
• 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
• 2+ years of experience processing medical, dental, prescription, and/or mental health claims
• Proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
• Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive  VoiceResponse (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group approved symptom screener prior to entering the work site each day, in order to keep our work sites safe.  Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained
• You will be asked to perform this role in an office setting or other company location

Careers with WellMed. Our focus is simple. We’re innovators in preventative health care, striving to change the face of health care for seniors. We’re impacting 240,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We’ve joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life’s best work.(sm)
 

Colorado Residents Only: The hourly range for Colorado residents is $17.12 to $30.34. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary,  UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.
 
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment

 
Job Keywords: Senior Claims Examiner, San Antonio, TX, Texas, Healthcare, health care, Managed Care, Billing Representative, Billing, Collections, Claims, Customer Service, Medical Billing