Associate Claims Representative - Brentwood, TN

Position Description:

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You dream of a great career with a great company - where you can make an impact and help people.  We can offer you just this. And with the incredible growth of our business, it’s a dream that definitely can come true when you join us as an Associate Claims Representative. Already one of the world’s leading health care companies, Optum is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives.  Whether you have prior experience or not, we’ll provide extensive training and a highly supportive environment for all of our Claims team members. This is your opportunity to make a difference, grow your career and do your life’s best work.

As an Associate Claims Representative, you’ll be responsible for handling incoming healthcare claims ensuring a high level of customer service and maximizing productivity by processing claims accurately, the first time. You’ll put your skills and talents to work as you review, research, and process medical claims. It's complex, detailed work. It's a 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. 

This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8 hour shift schedules during our normal business hours of (6am to 6pm). It may be necessary, given the business need, to work occasional overtime or weekends. Our office is located at 7105 Moores Lane, Brentwood TN.

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Primary Responsibilities:

• Review and research assigned claims by navigating multiple computer systems and platforms and accurately capturing the data/information necessary for processing (e.g. verify pricing, prior authorizations, applicable benefits)
• Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/ certificates)
• Complete on a daily basis all data entry required to document and communicate the status of claims as needed adhering to all reporting requirements
•  Communicate and collaborate with members and providers to resolve claims errors/issues, using clear, simple language to ensure understanding
• Learn and leverages new systems and training resources to help apply claims processes/procedures appropriately (e.g. on-line training classes, coaches/mentors)
• Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction and attendance