Claims Representative - National Remote - UnitedHealth Group : Job Details

Review, research, analyze and process complex healthcare claims by navigating multiple computer systems and platforms and accurately capturing the data/information for processing (e.g. verify pricing, prior authorizations, applicable benefits) Ensure that the proper benefits are applied to each claim by using the appropriate tools, processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/ Medicare guidelines, benefit plan documents/ certificates tool) Complete data entry for all daily documentation and communicate the status of claims adhering to reporting requirements Communicate through correspondence with members and providers regarding claim payment or required information using clear, simple language to ensure understanding Learn and leverage new systems and training resources to help apply claims processes/procedures appropriately (e.g. on-line training classes, coaches/mentors) Meet and maintain the performance goals est...Claims Representative, Claims, Representative, Remote, Processing, Health, Insurance, Healthcare