Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.This position is full-time (40 hours/week) Monday to Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 7:00pm local time.We offer 2-3 weeks of paid virtual training. The hours during training will be 7:00am to 7:00pm local time, Monday - Friday. Training will be conducted virtually from your home.You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities:
Work independently while meeting appropriate deadlines consistently.
Work with minimal guidance; seeks guidance on complex tasks.
Act as a resource for others– primarily within the department, but also representing Behavioral Health Claim Operations across the enterprise.
Outbound calls to providers
Coordinate own activities, work is self -directed and not prescribed.
Plan, prioritize, organize, and complete work to meet established objectives.
Identify and resolve claim basic operational problems using defined processes, expertise, and judgment.
Investigate claim issues as identified and communicate resolution to internal customers.
Identify root cause of issues.
Development and documentation processes for accurate and efficient claim payment
Anticipate customer needs and proactively identifies solutions.
Call upon others for assistance outside scope and with large, complex issues.
Refer misdirected issues to non-claim teams.
Provide expertise and customer service support to internal customers.
Communicate research findings to applicable stakeholders.
Review assigned CPEWS, Adjustment Trends, Denial Trends alerts in an accurate and timely manner and acting as appropriate.
Apply knowledge / skills to identify and remediate straightforward claim issues.
Other duties as assigned.
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
2+ years of claims processing OR adjustment
Intermediate knowledge Microsoft Word (create and edit correspondence)
Intermediate knowledge Microsoft Excel (ability to create, edit, and sort spreadsheets, basic analytical formulas (vlookup, if))
Intermediate knowledge Microsoft Outlook (email and calendar management)
Intermediate knowledge Microsoft PowerPoint (ability to create and edit slides)
Knowledge of the healthcare industry (e.g., billing practices, terminology, legal/regulatory requirements, coding standards, healthcare reform)
Ability to identify and interpret applicable provider contract information (e.g., in-network vs. out-of-network, contracted rates, shared savings)
Ability to work full-time (40 hours/week) Monday to Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 7:00pm local time
Preferred Qualifications:
2+ years of customer service experience
2+ years of experience as a Claim SME or Provider Operations SME
2+ years of Adjustment experience
Knowledge of how to use and navigate NDB
Macro development
Intermediate level of Microsoft Visio (create, edit, format, manipulate data)
Knowledge of how to utilize and navigate applicable claims processing systems, platforms and databases (e.g., UNET or COSMOS or CSP Facets or OBH Facets)
Telecommuting Requirements:
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.
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C., Maryland Residents Only: T he hourly range for this role is $23.22 to $45.43 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.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 .#RPO