UnitedHealth Group Claims Representative – Remote in Pacific, Mountain or Central Time Zone in Dallas, Texas
Job Description
If you are located within Pacific, Mountain OR Central time Zone, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges.
OptumRx is an empowering place for people with the flexibility to help create change. Innovation is part of the job description. And passion for improving the lives of our customers is a motivating factor in everything we do.
If you’re ready to talk about groundbreaking interactions, let’s talk about what happens when a firm that touches millions of lives decides to gather results from millions of prescriptions every month and analyze their impact. Let’s talk about smart, motivated teams. Let’s talk about more effective and affordable healthcare solutions. This is caring. This is great chemistry. This is the way to make a difference. We’re doing all this, and more, through a greater dedication to our shared values of integrity, compassion, relationships, innovation and performance. Join us and start doing your life’s best work. SM
This position is full-time (40 hours/week) Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:30am – 4:00pm Pacific Time Zone. It may be necessary, given the business need, to work occasional overtime and/or weekends.
We offer 2 weeks of paid training which will consist of modulars/learn sources and will pair with SME or Senior Claims Representative for on-the-job training for up to 60 days. The hours during training will be 7:30am to 4:00pm PST, 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:
Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing, and adjusting claims
Analyze and identify trends and provide reports as necessary.
Consistently meet established productivity, schedule adherence and quality standards
This is a challenging role that takes an ability to thoroughly review, analyze and research complex healthcare claims 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 support 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 OR equivalent years of work experience
1+ years of experience in a healthcare related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools
Basic proficiency with Microsoft Office Outlook (email) and Microsoft Word (creating and/or edit existing docs/templates)
Ability to work from Monday – Friday 7:30am – 4:00pm Pacific Time Zone, including the flexibility to work occasional overtime and weekends as the business need
Must be 18 years of age OR older
Preferred Qualifications:
1+ years of experience processing pharmacy or prescription claims, OR in a PBM (pharmacy benefit setting OR environment)
Experience using Microsoft Teams OR Excel
Pharmacy Tech experience
Ability to learn new and complex computer system applications
Telecommuting Requirements:
Reside within the Pacific, Mountain OR Central Time Zone
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
Making claims a positive experience for our members can drive your sense of impact and purpose. Join us as we improve the lives of millions. Learn more about how you can start doing your life’s best work. SM
California, Colorado, Nevada or Washington Residents Only: The hourly range for California / Colorado / Nevada / Washington residents is $16.54 – $32.55 per hour. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
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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