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in Eden Prairie, MN

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Hours Full-time, Part-time
Location Eden Prairie, MN
Eden Prairie, Minnesota

About this job


Position 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.



 



Optum is an industry leader in delivering health care solutions. Optum
is a multi-faceted organization dedicated to reducing economic loss in the
health care industry.  This is
accomplished in part by the detection and investigation of suspect claims for our
clients. The Non-Clinical Investigator is responsible for researching and
investigating the suspect claims to determine if  further 
review of the claim is warranted. 
This is done by investigating the reason the claim was stopped, the
provider and member information, the billed charges and comparing all
information to the medical records.  The
ideal candidate will use critical thinking skills to ultimately pay or deny the
claim or send the information to our clinical team for further review.



 



Primary Responsibilities:

  • Investigate claims to identify fraudulent claim
    submissions or aberrant billing practices.
  • Effectively handle their caseload, monitor
    mandated and internal turn-around time requirements.
  • Document in accordance with investigative
    standards, all investigative activity and findings in proprietary database.
  • Follow Department Standards Operating Procedures
    and Corporate Policies
  • Communicate Claim Processing instruction.
  • Conduct Internet research
  • Perform analysis of claim data as needed
  • Monitor the effectiveness of the investigative
    findings, for their Regions, making recommendations for flag addition, removal,
    or revision, to include Provider Education, Recovery or referral to GCA when
    appropriate.
  • Ability to work in a production environment and
    meet stated production goals.

Requirements

 Requirements:

  • High school diploma or GED
  • 1+ year of customer service experience analyzing and solving customer problems
  • CPT or Diagnosis code experience or experience using claims platforms such as UNET, Pulse, NICE,Facets, Diamond, etc
  • Working knowledge of medical terminology and claim coding
  • Beginner level of proficiency with Excel and Word

Assets:

  • Bachelor's degree in criminal justice, Certified Fraud Examiner, a Medical Coding Certificate.
  • Previous experience in claim processing, healthcare provider information and healthcare billing practices

Soft Skills:

  • Strong analytic and problem solving skills
  • Strong written and verbal communication skills.

Physical Requirements and Work Environment:

  • Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods working at a computer
  • Service center environment with moderate noise level due to Representatives talking, computers, printers, and floor activity

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.

 

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.