Medical Claim Analyst

UnitedHealth Group•Tampa, FL

2d•$18 - $32•Remote

About The Position

This position is National Remote. You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together. A Medical Claims Analyst (MCA) is responsible for the intake processing and triage of all initial claim documents in a high-volume environment. This includes but is not limited to referral processing, obtaining required documents, medical records sorting and processing, preparing payment calculations, preparing the claim for a Nurse review, apply all Nurse findings to the claim, prepare and send reports, prepare and send provider packets. 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 8:00 am - 5:00 pm MST. It may be necessary, given the business need, to work occasional overtime. We offer 4 weeks of paid on-the-job training. The hours of training will be aligned with your schedule during normal business hours. 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. 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.

Requirements

High School Diploma / GED OR equivalent years of work experience
Must be 18 years of age OR older
1+ years 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
Experience with Microsoft Word (create correspondence and work within templates) and Microsoft Outlook (email and calendar management)
Intermediate experience with Microsoft Excel (Sorting and filtering data, using formulas, and working with Tables)
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 8:00 am - 5:00 pm MST. It may be necessary, given the business need, to work occasional overtime.

Nice To Haves

1+ years of experience processing medical, dental, prescription or mental health claims
1+ years of experience processing insurance claims or billing/collections in a healthcare or commercial setting
Familiarity with UB04’s
Ability to understand and maintain HIPAA confidentiality and privacy standards when completing assigned work
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

Responsibilities

Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims
Analyze and identify trends and provide reports as necessary
Consistently meet established productivity, schedule adherence and quality standards