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Claims Specialist - Eden Prairie, MN

UnitedHealth Group


Location:
Eden Prairie, MN
Date:
09/05/2017
2017-09-052017-10-04
Job Code:
1779764
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Job Details


Claims Specialist - Eden Prairie, MN(Job Number:728036)
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.
 
As a Claims Specialist, you will help us serve as a third-party administrator for the State of Minnesota Medicaid LTSS (Long term Service and Support) program by supporting front line staff in the delivery of an exceptional experience to healthcare providers. In this role, you will be working with the client in planning, recommending, and executing the investigation and disposition of complex claims issues, reporting outcomes, and identifying and implementing process improvements.
 
Primary Responsibilities:
 
Claims Research and Resolution:
  • Ensure accurate interpretation of claims requirements and definitions.
  • Understand the claims processing system logic and rules and their impact to the payment process.
  • Examine complex claims for appropriateness and completeness of information in accordance with coverage guidelines.
  • Ensure timely delivery of claims adjudication and payment to providers.
  • Identify root causes of claims processing errors, or payment delays.
  • Assist the management team in problem resolution, planning and overseeing workflows; prepare / update documentation; as well as providing recommendations to improve workflows and departmental efficiencies.
 Customer Support:
  • Provide training / education on claims business processes to Senior Communication Specialists (SCS).
  • Documents the claims investigation outcomes clearly and concisely for SCS follow up calls.
  • Provides real time responses to SCS team to support one call resolution.
  • Provide back up to the SCS on inbound calls as needed to meet service levels.
  • Place outbound follow up calls with on escalated issues.
Client Support:
  • Obtain and validate business requirements from the client such as the plan documentation, provider manuals, etc.
  • Provide on-going communication updates to client on progress and outcomes of claims issues and process improvements.
  • Extract claims processing data from system and provide to clients as required.
 Systems and Processes:
  • Identify / analyze potential solutions to claims business processes problems / issues (quality improvement, processing accuracy.)
  • Develop and maintain detailed process documentation.
  • Document and communicate claims business process information.
  • Monitor effectiveness of business process changes (e.g., quality, accuracy, turnaround time, key performance metrics.)
  • Update process documents to reflect changes in claims business processes.

Job Claim Business Process
Primary Location US-MN-Eden Prairie
Other Location 
Organization Government Solutions Sr Mgmt
Schedule Full-time
Number of Openings 2
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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