Issue Resolution Claims Specialist - Adjust and Process Claims - UnitedHealth Group - West Valley City, UT

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)

The purpose of this position is to delight our customers by resolving their issues through fast and accurate problem identification, accurate resolution of closed and denied claims,  adjustments and escalated claim issues. Another purpose of this position is to support the mission, vision and values of the organization and department through quality, service, innovation, integrity, teamwork and dignity/respect. The employee specifically contributes to organizational/ departmental success.

Primary Responsibilities:

• Providing Excellent Claims Issue Resolution


• Process identification and process improvement


• Accurately identify and assess claims adjustments/issues


• Investigate and respond to written and verbal inquiries received from external sources


• Research and respond to inquiries or requests from management or internal sources


• Maintain proficiency in all technical system applications


• Accountable for claim reconsiderations and to communicate resolution to appropriate parties


• Investigate issues and document steps taken to achieve resolution


• Demonstrate a cooperative, positive attitude in the workplace


• Demonstrate knowledge of managed healthcare and claims


• Handle special projects as required

Required Qualifications:

• 2+ years of medical claim processing experience


• An education level of at least a high school diploma, GED or 5 years of equivalent working experience


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


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

Preferred Qualifications:

• Medicare experience

Physical Requirements and Work Environment:

• Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouse


• Office environment

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

Job Keywords: claims processing, medical claims, healthcare, medicare, West Valley City, UT