Medical Claims Representative 2374501 | Las Vegas, NV

Medical Claims Representative

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

The Medical Claims Representative works under minimal supervision adjudicating complex and specialty claims. They release designated pending claims to achieve established production, quality, and cycle time standards in accordance with Evidence of Coverage, Benefit Schedules and contractual arrangements. They monitor and report desk inventory notifying management of problem identification. This role is primarily focused on claims analysis and adjudication and does not include inbound or outbound customer service phone responsibilities.

If you're looking for a role where you can leverage your skills to connect people, translate ideas into action, and drive meaningful outcomes, this could be the perfect fit.

What are the reasons to consider working for UnitedHealth Group? Put it all together - a highly competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success.

Some of our offerings include:

• 18 days of Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-Term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement - up to $5,250 per calendar year for job-related coursework
• Adoption Assistance Plan
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

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 6:00 am - 5:00 pm. Alternate schedules are available for those who would prefer to work four 10-hour shifts from Monday - Friday as long as employees are working the hours per business need. It may be necessary, given the business need, to work occasional overtime.

We offer up to 4 - 6 weeks of paid training. The hours during training will be 7:00 am - 3:30 pm PST, Monday - Friday. Training will be conducted onsite.

Primary Responsibilities:

• Adjudicate claims in accordance with established quality and production standards
• Monitor work inventory and submits required reports accurately and by established deadlines
• Analyze medical claims to ensure accurate adjudication in accordance with Evidence of Coverage (EOC) documents, Benefit Schedules, and Provider Contracts
• Release claims within established timeframes to meet company requirements, state regulations, contractual obligations, and performance standards
• Identify processing issues and reports findings to management
• Resolve priority projects and complex assignments
• Perform all job functions with a high degree of discretion and confidentiality in compliance with federal, company, and departmental confidentiality guidelines

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School Diploma / GED OR equivalent years of work experience
• Must be 18 years of age or older
• 1+ years of medical claims processing experience in working with HMO / PPO or indemnity claims
• 1+ years of experience with Medical terminology, ICD-10, or CPT coding with an understanding of Insurance Certificates, Benefit Schedules, Provider / Group Contracts and Standard Insurance Industry Practices
• Must be willing to interview onsite at 2720 N. Tenaya Way, Las Vegas, NV, 89128
• Must be willing to work onsite at 2720 N. Tenaya Way, Las Vegas, NV, 89128
• Ability to work 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 6:00 am - 5:00 pm. Alternate schedules are available for those who would prefer to work four 10-hour shifts from Monday - Friday as long as employees are working the hours per business need. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications:

• 2+ years of medical claims processing experience in working with HMO / PPO or indemnity claims
• 2+ years of experience with Medical terminology, ICD-10, or CPT coding with an understanding of Insurance Certificates, Benefit Schedules, Provider / Group Contracts and Standard Insurance Industry Practices
• 1+ years of experience in Medical / Dental insurance, office or medical billing setting

Soft Skills:

• Must possess understanding of basis mathematics
• Knowledge of, or capacity to learn and apply, applicable federal and state laws, regulations, policies, and industry guidelines related to healthcare claims processing and operational compliance
• Experience working in a high-volume production environment while consistently meeting established productivity and quality standards
• Demonstrated analytical reasoning, critical thinking, and problem-solving skills
• Adaptability to change and flexibility are key to success in the role, along with the ability to maintain a positive work ethic

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $18 - $32 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.