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Senior Claims Representative

UnitedHealth Group

San Antonio, TX
Job Code:
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Job Details

Senior Claims Representative(Job Number:702865)

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)
This position is responsible for accurate and prompt payment of claims, in addition to reporting of statistics/data and handling complex claims pricing methodology. The Sr. Claims Examiner functions as a subject matter expert, and provides guidance to Claims Examiners on more complex issues. Examiners are responsible for adjudication of all claims. Examiners are responsible for handling customer service calls as needed, recalculating claims on an as needed basis. Examiners will be expected to maintain production and quality standards.
Primary Responsibilities:
  • Coordinates with the Claims Manager and/or Claims Supervisor on workflow issues and the handling of batches in date order
  • Documents all claims production via the system BA screen (which tracks individual examiner production); online transactions to be tracked separately
  • Responsible for weekly/monthly goal of batches to include meeting and maintaining a 95% quality standard and production standard of 35 claims per hour on transactions
  • Evaluates each claim for appropriate coding of CPT and ICD codes against charges that are being billed and entered
  • Responsible for inputting accurate batch accounts, invoice numbers, status codes to ensure accurate entry into Claims Processing system, which creates reporting
  • Must meet and maintain 95% quality expectations; these are identified via errors tracked on phone calls, overpayments, unsolicited checks, appeals, TDI complaints and errors on processing
  • Responsible to create and generate any overpayment documentation (notes in system, letter to typing) on all overpayments created by the examiner or any overpayments identified by examiner
  • Takes ownership of the total work process and provides constructive information to minimize problems and increase customer satisfaction
  • Performs all other related duties as assigned

Job Claim Operations
Primary Location US-TX-San Antonio
Other Location 
Organization WellMed Medical Mgmt, Inc
Schedule Full-time
Number of Openings 1
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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