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Healthcare Claims Representative - Ontario, CA

UnitedHealth Group


Location:
Ontario, CA
Date:
06/23/2017
2017-06-232017-07-22
Job Code:
1753143
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Job Details


Healthcare Claims Representative - Ontario, CA(Job Number:715644)
Description

A Healthcare Claims Denial Coordinator is responsible for monitoring her own work queue.  On a regular day, the denial letter coordinator will run her queue report for compliance purposes.  She will work on any claims close to compliance, including:

  • Eligibility claims - DC will call the health plan or go on health plan website to verity eligibility.  Responsible for taking the appropriate steps to get the claim finalized and/or issue denial letter.

  • Out of network claims - DC will contact referring physician or billing provider to verify if/how member was referred.  With that information DC will finalize the claim accordingly and/or issue denial letter.

All denial letters are reviewed by Supervisor for accuracy and appropriateness. 

 

Primary Responsibilities:

  • Follows policy and procedures regarding Denial Process

  • Orients internal staff to current changes in Denial Process

  • Works closely with Compliance Dept. to insure that denial letters have appropriate language as delineated by NAMM California, Health plans, CMS and DHMC

  • Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims

  • Analyze and identify trends and provides reports as necessary

  • Consistently meet established productivity, quality, and compliance standards

  • Provide excellent customer service

  • Ability to work as a team player

  • Ability to access health plan websites and verify eligibility information


Job Claim Operations
Primary Location US-CA-Ontario
Other Location 
Organization NAMM California
Schedule Full-time
Number of Openings 1
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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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