Claims Adjustment Representative - Richardson, TX - Full-time / Part-time

Get the training you need to build the success you want. Classes starting soon, so apply today!What’s your next move? How about right to the leading edge of health care - where you’ll find UnitedHealth Group setting the pace for quality, service and employee development. In fact, that’s more than a move, it’s a leap. Join one of our high performing teams and you can play a critical role in creating a quality experience for our members and providers. Take your current claims knowledge add our outstanding training program and support and see how your knowledge, job satisfaction and career will grow.   If you have a high degree of personal accountability, attention to detail and a love of problem-solving, we can provide the challenge you need and the career opportunities you want. This could be your opportunity to expand your career as you do your life’s best work. (SM)When you join our team as a Claims Adjustment Representative, you’ll be responsible for reviewing and making adjustments or corrections to processed claims through researching, investigating issues, making a determination and then communicating as required. You will authorize the appropriate adjustment or sometimes refer the claims to other team members for further review. Conducting data entry and re-work; analyzing and identifying trends as well as providing reports as necessary will also be a part of your daily routine.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 1311 W. President George Bush Highway, Richardson, TX. Primary Responsibilities:Review and research  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, coding)Update claim information based on research and communication from member or providerComplete necessary adjustments to claims and ensures 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 requirementsCommunicates extensively with members and providers regarding adjustments 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  

Required Qualifications:Minimum 1 year Customer Service Representative (CSR) experience or 1 year experience in an office setting, call center setting or phone support  roleAn education level of at least a high school diploma or GED OR 10 years of equivalent working experienceFamiliarity and fluency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applicationsAbility to compose written correspondence free of grammatical errors while also translating medical and insurance expressions into simple terms that members can easily understandAbility to remain focused and productive each day though tasks may be repetitiveAbility to multi-task, including the ability to understand multiple products and multiple levels of benefits within each productConsistent attendance with ability to meet work schedule including the required training periodSuccessful completion of the UnitedHealth Group new hire training and demonstrated proficiency required Preferred Qualifications:Previous experience with medical claims processing preferred There are several steps in our hiring process - it’s a thorough process because we want to ensure the best job and culture fit for you and for us. In today’s ultra-competitive job market, the importance of putting your best foot forward is more important than ever. And you can start by completing all required sections of your application. (i.e. profile, history, certifications and application/job questions). Once you submit your resume, you’ll receive an email with next steps. This may include a link for an on-line pre-screening test that we ask you to complete as part of our selection process.  You may also be asked to complete a digital video interview, but we will offer full instructions and tips to help you. After you have completed all of these steps, you can check on the status of your application at any time, but you will also be notified via e-mail. http://uhg.hr/OurApplicationProcessCareers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SMDiversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.Keywords: claims, medical claims, healthcare claims, claims processing, claims processor; office, UnitedHealth Group, UnitedHealthcare,  training class, customer service representative, customer service, CSR, Data Entry, appeals, dispute resolution, phone support