Claims Adjustment Representative - Remote in TN

If you are located within the state of Tennessee, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges.

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life's best work.SM

The health care system is still evolving at a rapid pace. Technology is driving new advances in how patient care is delivered and how it's reimbursed. Now, UnitedHealth Group invites you to help us build a more accurate and precise approach to claims adjudication. In this role, you'll be responsible for reviewing and making adjustments or corrections to processed claims through researching, investigating issues, making a determination and then communicating as required. Using multiple platforms, you'll also assist with pricing verification, prior authorizations, benefits and coding. Join us and build your career with an industry leader.

This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends.

We offer 12 weeks of paid training. The hours during training will be 7:30am-4:30pm CST (hours subject to change, Monday - Friday. Training will be conducted virtually from your home.

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

Primary Responsibilities:

• Update claim information based on research and communication from member or provider
• Complete necessary adjustments to claims and ensure the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates)
• Communicate extensively with members and providers regarding adjustments to resolve claims errors/issues, using clear, simple language to ensure understanding
• Learn and leverage new systems and training resources to help apply claims processes/procedures

This is a challenging role with serious impact. You'll be providing a high level of support and subject matter expertise within a fast paced, intense and high volume claims operation where accuracy and quality are essential. Multitasking in this role is required to conduct data entry and rework, analyzing and identifying trends as well as completing reports daily.

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 equivalent work experience
• Must be 18 years of age or older
• 6+ months of claim processing experience or medical or insurance experience
• Ability in using computer and Windows 365 applications, which includes the ability to learn new applications
• Ability to work our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends.

Preferred Qualifications:

• 2+ years of experience processing original claims or reworks
• 1+ years of experience of Medicaid and Medicare policies and regulations
• Experience working with Microsoft applications (Teams, Outlook, Excel, PowerPoint- sorting data, basic formulas, v-lookup, and pivot tables within MS Excel)
• Claim processing experience in Facets (CSP Platform)

Telecommuting Requirements:

• Reside within the state of TN
• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

Soft Skills:

• Ability to compose grammatically correct correspondence that translates medical and insurance expressions into simple terms that members can easily understand
• Results-oriented

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for 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.

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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