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Healthcare / Medical Claims Examiner - La Palma, CA

UnitedHealth Group


Location:
PALMA, CA
Date:
08/22/2017
2017-08-222017-09-20
Job Code:
1767183
Apply on the Company Site
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Job Details


Healthcare / Medical Claims Examiner - La Palma, CA(Job Number:722816)
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


Job Claim Operations
Primary Location US-CA-LA PALMA
Other Location 
Organization AppleCare
Schedule Full-time
Number of Openings 4
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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