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Healthcare / Medical Claims Examiner - La Palma, CA

UnitedHealth Group

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Job Details

735880 Healthcare Medical Claims Examiner La Palma CA

Healthcare / Medical Claims Examiner - La Palma, CA (735880)

Position Description

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.(sm)


To process the medical claims of the company’s IPA clients pursuant to designated production quotas for accuracy and productivity benchmarks.

Primary Responsibilities:

  • Batch and prioritize claims processing utilizing the Company’s in-house claims processing system*

  • Verify patient’s accounts for eligibility and benefits

  • Process complex claims that have been accepted for payment*

  • Request and follow-up on additional information as needed for incomplete claims*

  • Complete all steps above within designated timeframes (production quotas) and notify management if claims cannot be processed within the designated time frame*

  • Assemble denial letter background information and generate denial letters*

  • Read, interpret and summarize medical contracts / division of responsibility

  • Identify claims that are not our financial risk and forward to appropriate entity for payment

  • Review claims that are pending and follows through for payment in a timely manner

  • Treat peers, superiors, subordinates clients and vendors with fairness, courtesy and professionalism and contribute to the overall positive work environment of the department

  • Complete other production projects as assigned

Required Qualifications:

  • 3+ years of experience working as a Healthcare / Medical "Claims Examiner"

  • Strong proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications


Preferred Qualifications:

  • An education level of at least a high school diploma or GED OR 10 years of equivalent working experience

  • Experience working on claims in a managed care setting

  • Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product

  • Demonstrates excellent interpersonal skills as discerned through observation and team project successes

  • Accurately interprets and applies departmental policies and procedures using sound judgment as is related to claims processing

  • Communicates clearly, professionally and respectfully to peers, superiors, subordinates and clients

  • Meets production quota for both input levels and accuracy on a weekly basis as set forth by the department standards

  • Efficiently organizes and prioritizes workflow

  • Provides constructive feedback on work projects assigned

  • Consistently produces accurate and timely work product as it relates to departmental goals

  • Demonstrates high reliability through consistent punctuality and attendance

  • Demonstrates overall professionalism in attitude, demeanor and personal appearance



AppleCare Medical Management Group was incorporated in 2003. Over the last 17 years, the multispecialty medical group of independent practices has expanded into new communities, contracted with more hospitals and health plans, and added over 50 new doctors - but the mission has remained the same. Today, AppleCare Medical Management is comprised of hundreds of board-certified private-practice, independent physicians. Collectively, our physicians have been serving the Southeast area of Los Angeles and Northern Orange County for decades, providing their medical expertise and passion to improving the health of our communities.



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.



Job Keywords: Claims processor, denial process, compliance, healthplans, CMS, DHMC, La Palma, CA, California

Job Details

  • Contest Number735880
  • Job TitleHealthcare / Medical Claims Examiner - La Palma, CA
  • Job FamilyClaims
  • Business SegmentOptumCare

Job Location Information

    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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