Position Description:Energize your career with one of Healthcare's fastest growing companies. You dream of a great career with a great company - where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it's a dream that definitely can come true. Already one of the world's leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up. This opportunity is with one of our most exciting business areas: Optum - a growing part of our family of companies that make UnitedHealth Group a Fortune 6 leader. Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation and Performance.Responsible for verifying Medi-Cal Eligibility; determining coordination of benefits (COB); processing Fee for Service (FFS) and Child Welfare Services (CWS) provider claims; answering provider questions; providing back up for Claims Service Representatives as needed.Primary Responsibilities:Process provider claims with a minimum of 97% procedural accuracy and 99% financial accuracy.Maintain daily claims production standard.Maintain working knowledge of plan benefit designs.Analyze and authorize claim payments according to policies and provisions of plan.Handle priority claim requests timely and accurately.Review and complete pended claims on a daily basis.Enter and update client demographics and insurance information into the Designated Data System (DDS).Process the Medi-Cal denials received by Billing Unit and Medi-Cal denied Services Report within established time frames.Recoup paid claims determined to have been paid in error.Position requires access to electronic applications and documents which contain Individually Identifiable Health Information and Personal Health Information.Assist with taking provider calls, as needed.
Required Qualifications:High School Diploma / GED2+ years of claims processing experience in a managed care environmentAbility to work from 8:00 AM - 5:00 PM, Monday through Friday, in PSTProficiency with Microsoft Word (ability to create and edit documents), Microsoft Excel (enter data on an existing spreadsheet, filter, and sort), and Microsoft Outlook (manage email and calendar)Upon Hire, you will be required to be granted and maintain access to the County of San Diego's electronic health record, CCBH (Cerner Community Behavioral Health) SystemPreferred Qualifications:10-key calculator experienceSoft Skills:Team player with ability to communicate well with other staff members throughout the company.Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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. 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. In addition, employees in certain positions are subject to random drug testing.Keywords: UHG, UnitedHealth Group, Claims Representative, claims, claims processing, Medi-Cal
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.