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Senior Claims Representative - Eden Prairie, MN

UnitedHealth Group

Eden Prairie, MN
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Job Details

739582 Senior Claims Representative Eden Prairie MN

Senior Claims Representative - Eden Prairie, MN (739582)

Position Description

This is an opportunity that’s all about where you’ve been. Your experience. Your potential. Your skills. Because on the team at UnitedHealth Group, your potential and your impact can be career changing. No company has put together better teams of passionate, energetic and all out brilliant Claims Representatives. This is where you come in. We’ll look for your experience and expertise to help keep our service levels and accuracy extremely high. We’ll also look for your ideas on how to constantly evolve our claims processes. We’ll back you with the great training, support and opportunities you’d expect from a Fortune 6 leader.


We are seeking a motivated individual to join our team as a Medical Claims Quality Analyst. Positions in this function are responsible for providing expertise in claims/EOB knowledge. Individuals in this position will review and analyze data, present information related to facility claim information in an attempt to identify trends, competitor reimbursement and contract practices. Individuals will also contribute to development and implementation processes and business solutions through research and analysis of data. 


Primary Responsibilities:

  • Use pertinent data and facts to identify and solve a range of problems within area of experience
  • Understand and interpret explanations of benefits (EOB) data from variety of carriers in a variety of formats
  • Basic analysis and investigation of  trends in the data and competitors product and rates
  • Retrieve and interpret claim reports to assist with efficient and accurate documentation of claims for delivery to internal and external customers
  • Research, identify and obtain data/information needed to help accurately interpret the data as needed
  • Provide feedback to co-workers through peer review process
  • Anticipate customer needs and contribute to proactive identification of solutions
  • Other duties as deemed appropriate to provide a quality, timely product for delivery to our customer

This is a challenging role that takes an ability to thoroughly review, analyze and research complex health care claims in order to identify discrepancies, verify pricing, confirm prior authorizations and process them for payment. You’ll need to be comfortable navigating across various computer systems to locate critical information. Attention to detail is critical to ensure accuracy which will ensure timely processing of the member's claim.

Required Qualifications:

  • 2+ years of medical claims adjudication and/or claim customer service experience with exposure to Coordination of Benefit (COB) and/or interpretation of Explanation of Benefits (EOB)
  • 1+ years of data analysis (finding trends in data including plans, products and network rate differentials)
  • 1+ years of MS Excel experience (formulas, sorting, filtering, formatting, V-lookups etc.)

Preferred Qualifications:

  • Associate's degree
  • Medical coding/billing/CPT Codes
  • Knowledge of UNET/NDB, iDRS/EDSS and/or ppoONE
  • MS Office software
  • Well organized with ability to multitask in a fast-paced environment
  • Experience managing to deadlines
  • Excellent written and verbal communication skills
  • Self-driven, ability to work independently and facilitate change

Making claims a positive experience for our members can drive your sense of impact and purpose. Join us as we improve the lives of millions. Learn more about how you can start doing your life’s best work.(sm)



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.


UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.



Job Keywords: Medical Claims, hospital, reimbursement, Optum, research, Culture, Eden Prairie, MN

Job Details

  • Contest Number739582
  • Job TitleSenior Claims Representative - Eden Prairie, MN
  • Job FamilyClaims
  • Business SegmentOptumInsight

Job Location Information

  • Eden Prairie, MN
    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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