Claims Examiner II - Ontario, CA - Full-time / Part-time

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) 
 
Primary Responsibilities: 


Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims 

Authorize appropriate payment or refer claims to investigators for further review 

Analyze and identify trends and provides reports as necessary 

Consistently meet established productivity, schedule adherence, and quality standards 

Provide excellent customer service  

Excellent Data Entry skills needed 

Revenue and HCPCS coding skills helpful 

Experience in contract interpretation 

Medical Insurance Industry processing required 

Required Qualifications:

High School diploma or equivalent
2 years experience as a Medical Claims Examiner
Working knowledge of Medical Terminology, ICD9, CPT4, UB92/1500 forms
Excellent Data Entry skills
Experience in contract interpretation
Medical Insurance Industry processing Preferred Qualifications:

1 year experience of Professional claims processing
Prior Medicare, HMO experience
Revenue and HCPCS coding skills 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)
North American Medical Management, California, Inc (NAMM California) partnered with OptumHealth in 2012. NAMM California and OptumHealth share a common goal of bringing patients, physicians, hospitals and payers closer together in the mission to increase the quality, efficiency and affordability of care. NAMM California is a part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. NAMM California develops and managers provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations. For over 18 years, NAMM California has been an innovator in health care with a track record for quality, financial stability, extraordinary services and integrated medical management programs. NAMM California is well positioned to continually invest in its infrastructure and systems for the benefit of its provider clients and to accommodate the impending changes that will come forth from healthcare reform.   
   
The NAMM California provider clients represent a network of almost 600 primary care physicians and over 3,000 specialists and work with the premier hospitals in their respective markets.   
 

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and 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.
 
Job Keywords:  medical claims, claims processing, ICD9, medical coding, CPT, ICD10, Ontario, CA, California
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