Claims Representative - Las Vegas, NV

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)

Flexible, Friendly, Fast on your feet! That's a great start. Accurate, Accountable, Self-Directed! These traits can take you places. Our Claims Operations are the focal point of handling information about services patients receive and the way those services get paid. It's complex, detailed work. It's fast paced challenge. It's a job that calls on you to be thoughtful, resourceful, team-driven and customer-focused. To put it mildly, there is never a dull moment.

Under minimal supervision,  Claims Representatives adjudicate routine to complex claims & release designated pends to achieve established production, quality & cycle time standards - all in accordance with EOC, Benefit Schedules & contractual arrangements. Claims Representatives also monitor & report desk inventory and notify management of problem identification.

Primary Responsibilities:

• Adjudication of claims to quality & production standards applicable to this position


• Analyze medical claims to ensure accurate claims adjudication; claims processing in accordance with EOC, Benefit Schedules & Provider Contracts


• Release by deadline to meet Company, state regulations, contractual agreements & group performance standards


• Problem identification & reporting to management


• Resolution of priority projects


• Performs all job functions with a high degree of discretion & confidentiality in compliance with federal, HIPAA, PHI and departmental confidentiality guidelines


• Candidate should have some background in Medicare claims processing and understanding of Medicare benefits

Required Qualifications:

• High School diploma or GED


• Knowledge of medical terminology including ICD9 & CPT coding


• Certification in CPT coding or, 2+ years medical billing or, 2+ years in claims processing - where primary responsibility included actual claim processing in an HMO/ PPO or Medicare product

Preferred Qualifications:

• 1+ years of medical claims processing experience in HMO/ PPO or indemnity products or Medicare


• Clerical or administrative background in healthcare setting


• General knowledge of medical records, facility and professional claims is a plus!

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 biller, claims processor, claims research, Las Vegas, NV, Nevada