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Claims Adjustment Representative - Cypress, CA

UnitedHealth Group

Cypress, CA
Job Code:
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Job Details

738304 Claims Adjustment Representative Cypress CA

Claims Adjustment Representative - Cypress, CA (738304)

Position Description

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 17 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.

We are a small, but critical team processing commercial claims for a large state employer.

Primary Responsibilities:

  • Research, identify and obtain data / information needed to help process claims or resolve claims issues
  • Ensure that proper benefits are applied to every claim
  • Identify and knowledge of new plans / customers to process their claims appropriately
  • Identify and resolve claims processing errors / issues and trends, as needed
  • Resolve or address new or unusual claims errors / issues as they arise, ing appropriate knowledge or prior experience
  • Communicate and collaborate with external stakeholders to resolve claims errors / issues, using clear, simple language to ensure understanding
  • Collaborate with internal business partners to resolve claims errors / issues
  • Document and communicate status of claims / investigations to stakeholders as needed, adhering to reporting requirements
  • Achieve applicable performance metrics
  • appropriate processes and procedures to process claims (e.g., claims processing policies and procedures, grievance procedures, state mandates, CMS / Medicare guidelines, benefit plan documents / certificates)
  • Keep current on new product / service offerings and the value they provide
  • Communicate the value of our products and services to applicable audiences, using clear, simple language to ensure understanding
Required Qualifications:
  • High School Diploma / GED
  • 2+ years of medical claims processing with experience manually adjudicating claims.
  • Knowledge of applicable laws, regulations and compliance requirements to ensure that claims are processed properly (e.g., HIPAA, PPACA / Health Care Reform)
  • Must successfully complete new hire training courses

Preferred Qualifications:

  • Experience processing claims on the United Healthcare NICE claims platform
  • 6+ months of medical coding experience (ICD-9, ICD-10, CPT, etc.)                                            

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.

Keywords: claims, processing, NICE, HIPAA, Medicare, insurance, healthcare, United Healthcare

Job Details

  • Contest Number738304
  • Job TitleClaims Adjustment Representative - Cypress, CA
  • Job FamilyClaims
  • Business SegmentOptum Operations

Job Location Information

  • Cypress, CA
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusNon-exempt

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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