UnitedHealth Group Claims and Customer Service Representative - Horsham, PA in Horsham, Pennsylvania

It's that time, isn't it? You're ready for the next step forward and an opportunity to build on your skills. And it just so happens that there's never been a better time to get on the team at UnitedHealth Group. We've built one of the world's most effective and respected claims processing teams. And that's where you come in. We'll look to you to maintain our reputation for service, accuracy and providing a positive claims experience. We'll back you with the great training, support and opportunities you'd expect from a Fortune 6 leader.

This position is full-time (40 hours/week) Monday- Saturday. Employees are required to have flexibility to work any of our 8 hour shift schedules during our normal business hours of (8:00am - 7:00pm Monday through Friday and 4 to 5 Saturdays a year 12:00am - 5:00pm). It may be necessary, given the business need, to work occasional overtime. Our office is located at 680 Blair Mill Road, Horsham, PA 19044.

There are several steps in our hiring process. Please make sure that you have filled out all required sections of your employment application. Once you submit your completed application, you will receive an e-mail with information regarding next steps including any pre-employment assessment(s) that are required. Both your application and any required assessment(s) need to be completed before we can consider you for employment so the sooner you complete these two steps, the sooner you will hear from us. To learn more, go to: http://uhg.hr/OurApplicationProcess

Primary Responsibilities

  • Answer incoming phone calls from members and health care providers (i.e. physician offices, clinics) and identify the type of assistance the caller needs (i.e. benefit and eligibility, billing and payments, and/or explanation of benefits (EOBs)

  • Review and research incoming claims by navigating multiple computer systems and platforms and accurately capturing the data/information necessary for processing (e.g. verify pricing, prior authorizations, applicable benefits)

  • Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates)

  • Communicate and collaborate with members and providers to resolve claims errors/issues, using clear, simple language to ensure understanding.

  • Resolve issues on the first call, navigate through the appropriate computer system(s) to identify the current status of the issue and provide appropriate response to caller. Deliver all information and questions in a positive, conversational and compassionate manner to facilitate developing a relationship with the caller, while providing the best customer service experience possible

  • Constantly meet established productivity, schedule adherence, and quality standards

  • Processes claims according to specified procedures and standards, meeting all position production and quality standards.

  • Recognizes when to refer complicated claim situations to the various areas, outside firms and organizations. Submits and monitors claims referred to internal support units.

  • Handles complex claim situations. Analyzes and resolves problems from customers and providers. Selects and explains the best solution for the problem.

  • Project work as assigned

This is a challenging role that takes an ability to thoroughly review, analyze and research complex healthcare 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 support timely processing of the member's claim.

Requirements:

  • High school education or equivalent experience.

  • 1+ year of experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools

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

Preferred Qualifications:

  • 1+ year experience processing medical, dental, prescription or mental health claims

  • Demonstrated proficiency in using Microsoft Office (Outlook, Word & Excel) to complete work assignments

  • Authorization to work in the United States

Soft Skills:

  • Ability to navigate a computer while on the phone

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

Making claims a positive experience for our members can drive your sense of impact and purpose. Join us as we improve the lives of millions. Learn more about how you can start doing your life's best work.SM

Careers at UnitedHealthcare Medicare & Retirement.

The Boomer generation is the fastest growing market segment in health care. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care system. Ready? It's time 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.

Key words: Healthcare, health care, Managed Care, Billing Representative, Billing, Collections, Claims, Customer Service, Medical Billing