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Claims Adjustment Representative - Cypress, CA

UnitedHealth Group

Cypress, CA
Job Code:
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Job Details

Claims Adjustment Representative - Cypress, CA(Job Number:727495)

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
  • Apply knowledge of customer service requirements to process claims appropriately
  • Identify and apply 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, applying 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
  • Apply 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)
  • Leverage training resources to help apply claims processes / procedures appropriately
  • Collaborate with business partners to help address identified issues related to claims processes and procedures
  • Identify / develop / implement new claims processes procedures / solutions as needed, and document appropriately for future use
  • Demonstrate knowledge of applicable product / service offerings, and the value they provide to members and providers
  • Keep current on new product / service offerings and the value they provide
  • Demonstrate knowledge of benefit plan provisions and keep current on changes as they occur
  • Communicate the value of our products and services to applicable audiences, using clear, simple language to ensure understanding
  • Apply knowledge of products and services to process claims appropriately

Job Claim Operations
Primary Location US-CA-Cypress
Other Location 
Organization Optum Ops-Ireland All Others
Schedule Full-time
Number of Openings 1
Apply on the Company Site

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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