Senior Claims Representative

This position follows a hybrid schedule with 2-3 days in-office days per week. Our office is located at 5701 KATELLA AVE, Cypress, California.

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

This is an opportunity that's all about where you've been. Your experience. Your potential. Your skills. Because on the team at UnitedHealth Group, your potential and your impact can be career changing. No company has put together better teams of passionate, energetic and all out brilliant Claims Representatives. This is where you come in. We'll look for your experience and expertise to help keep our service levels and accuracy extremely high. We'll also look for your ideas on how to constantly evolve our claims processes. We'll back you with the great training, support and opportunities you'd expect from a Fortune 5 leader.

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 7am - 3pm PST. It may be necessary, given the business need, to work occasional overtime.

We offer 2-4 weeks of paid training. The hours of training will be based on your schedule.

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 provides 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
• Must be 18 years of age or older
• 3+ years of experience in a related environment (i.e. office, administrative, clerical, customer service, etc.)
• 1+ years of experience processing medical, dental, prescription 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
• Ability to work 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 7am - 3pm PST. It may be necessary, given the business need, to work occasional overtime

Telecommuting Requirements:

• Reside within commutable distance to the office at 5701 KATELLA AVE, Cypress, California
• 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:

• Works independently
• Mentors others
• Acts as a resource for others
• Coordinates others' activities
• Applies knowledge/skills to complex activities
• Demonstrates a depth and breadth of knowledge/skills in own area and is often able to apply these outside of own function
• Often acts as a technical resource to others in own function
• Anticipates customer needs and proactively identifies solutions
• Solves complex problems on own; proactively identifies new solutions to problems
• Plans, prioritizes, organizes and completes work to meet established objectives
• Acts as a facilitator to resolve conflicts on team; seen as key team member on project teams spanning more than own function

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20.00 - $35.72 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. 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.

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.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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