Medical Claims Representative Associate

Medical Claims Representative Associate

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 to start Caring. Connecting. Growing together.

The Medical Claims Representative Associate works under minimal supervision adjudicating routine to complex claims. They release designated pending claims to achieve established production, quality, and cycle time standards in accordance with EOC, Benefit Schedules and contractual arrangements. They monitor and report desk inventory notifying management of problem identification.

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 6:00 AM - 5:00 PM. It may be necessary, given the business need, to work occasional overtime.

We offer up to 4-6 weeks of paid training. The hours of training are Monday - Friday, 7:00am-3:30pm PST. Training will be conducted on-site at 2720 N Tenaya Way, Las Vegas, NV, 89128.

Primary Responsibilities:

• Adjudication of claims to quality and production standards applicable to this position.
• Monitor work inventory and keep Average Review Time (ART) within standard. Report non-productive time to management daily.
• Analyze medical claims to ensure accurate claims adjudication. Claims processing in accordance with EOC, Benefit Schedules and Provider Contracts.
• Release by deadline to meet Company, state regulations, contractual agreements and group performance standards.
• Problem identification and reporting to management.
• Resolution of priority projects.
• Performs all job functions with a high degree of discretion and confidentiality in compliance with federal, SHS and departmental confidentiality guidelines.

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
• Must be 18 years of age OR older
• 6+ months previous experience in Medical/Dental insurance, office or medical billing setting
• 6+ months experience with medical terminology, ICD-10, or CPT coding with an understanding of Insurance Certificates, Benefit Schedules, Provider/Group Contracts and Standard Insurance Industry Practices.
• 2+ years of experience in high-speed, accurate typing in a professional setting
• Reside within a reasonable commuting distance (typically within 30-60 minutes of travel time) of our office at 2720 N Tenaya Way, Las Vegas, NV 89128.
• Onsite work at this location is a mandatory requirement for the role.
• Ability to work (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 6:00 AM - 5:00 PM. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications:

• 1+ years medical claims processing experience working with HMO/PPO or indemnity claims.

Soft Skills:

• Must possess understanding of basic mathematics.
• Demonstrated knowledge of or ability to learn and apply to job functions, those federal and state laws and regulations applicable to the operating unit.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). The hourly pay for this role will range from $16.00 - $27.69 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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. UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.