Claims Clerk

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.

UMR, UnitedHealthcare’s third-party administrator (TPA) solution, is the nation’s largest TPA. When you work with UMR, what you do matters. It's that simple . . . and it's that rewarding.

In providing consumer - oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system. Opportunities are endless for your career development and advancement within UMR due to our record-breaking growth.

Regardless of your role at UMR, the support you feel all around you will enable you to do what you do with energy, quality, and confidence. So, take the first step in what is sure to be a fast - paced and highly diversified career.

The Claims Clerk is responsible for providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims.

This position is full time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 6:30 am - 9:00 pm CST. It may be necessary, given the business need, to work occasional overtime.

We offer 6-8 weeks of on-the-job / shadow based training. The hours during training will be 8:00 am to 4:30 pm CST, Monday - Friday. Duration for training is based on the individual candidate and their needs.

Primary Responsibilities:

• Provide general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims.
• Authorize the appropriate payment or refers claims to investigators for further review.
• Conduct data entry and re-work; analyzes and identifies trends and provides reports as necessary.
• Analyze and identify trends and provide reports as necessary.
• Consistently meet established productivity, schedule adherence, and quality standards.
• Recognize claims by determining claim type - HCFA, Hospital, UB, Dental and/or RX.
• Identify more complicated claims and refer them to Senior Claim Processor or Supervisor.
• Work claims files to ensure the appropriate eligibility and provider records are matched to the claim.
• Updates and maintains claims tracking database.

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 OR equivalent work experience
• Must be 18 years of age OR older
• 2+ years of experience with Microsoft Excel and Microsoft Outlook, including the ability to create, edit, save and send documents, spreadsheets and correspondence
• Basic proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
• Ability to work 6:30 am - 9:00 pm CST. It may be necessary, given the business need, to work occasional overtime

Preferred Qualifications:

• 2+ years of data entry experience
• 1+ years of experience working with medical claims
• 1+ years of working in production-based environment
• 1+ years of experience in an office setting environment using a computer as the primary instruments to perform job duties
• Ability to type 60+ WPM
• Basic understanding of healthcare claims including ICD-10 and CPT codes

Telecommuting Requirements:

• 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

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 $16 - $25 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 

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.