Medical Claims Examiner ($500 Sign-on External) - La Palma, CA

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.(sm)

To process the medical claims of the company?s IPA clients pursuant to designated production quotas for accuracy and productivity benchmarks.
Primary Responsibilities:

  • Batch and prioritize claims processing utilizing the Company?s in-house claims processing system

  • Verify patient?s accounts for eligibility and benefits

  • Process complex claims that have been accepted for payment

  • Request and follow-up on additional information as needed for incomplete claims

  • Complete all steps above within designated timeframes (production quotas) and notify management if claims cannot be processed within the designated time frame

  • Assemble denial letter background information and generate denial letters

  • Read, interpret and summarize medical contracts / division of responsibility

  • Identify claims that are not our financial risk and forward to appropriate entity for payment

  • Review claims that are pending and follows through for payment in a timely manner

  • Treat peers, superiors, subordinates clients and vendors with fairness, courtesy and professionalism and contribute to the overall positive work environment of the department

  • Complete other production projects as assigned

Required Qualifications:

  • Requires 3+ solid years of experience working as a Healthcare / Medical "Claims Examiner"

  • Strong proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications


Preferred Qualifications:

  • An education level of at least a high school diploma

  • Experience working on claims in a managed care setting

  • Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product

  • Demonstrates excellent interpersonal skills as discerned through observation and team project successes

  • Accurately interprets and applies departmental policies and procedures using sound judgment as is related to claims processing

  • Communicates clearly, professionally and respectfully to peers, superiors, subordinates and clients

  • Meets production quota for both input levels and accuracy on a weekly basis as set forth by the department standards

  • Efficiently organizes and prioritizes workflow

  • Provides constructive feedback on work projects assigned

  • Consistently produces accurate and timely work product as it relates to departmental goals

  • Demonstrates high reliability through consistent punctuality and attendance

  • Demonstrates overall professionalism in attitude, demeanor and personal appearance

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)


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.

Job Keywords: Claims examiner, denial process, compliance, healthplans, medical claims, CMS, DHMC, La Palma, CA, California


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