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Job Information

UnitedHealth Group Senior Claims Representative SME - Remote in Dallas, Texas

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

This is an opportunity that’s all about where you’ve been. Your experience. Your potential. Your skills. Because on the team at UnitedHealth Group , your potential and your impact can be career changing. No company has put together better teams of passionate, energetic and all out brilliant Claims Representatives . This is where you come in. We’ll look for your experience and expertise to help keep our service levels and accuracy extremely high. We’ll also look for your ideas on how to constantly evolve our claims processes. We’ll back you with the great training, support and opportunities you’d expect from a Fortune 10 company leader.

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 (6:00am - 6:00pm CST). It may be necessary, given the business need, to work occasional overtime.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

  • Assist with escalated claims to resolve complex issues for team members and internal customers

  • Support implementation of updates to the current procedures and assist with new system training/mentoring

  • Review guidelines as well as benefit plan documents and certificates to ensure proper benefits have been applied to each claim

  • Analyze and identify trends and provides reports as necessary

  • Partner with workforce to manage inventory

  • Lead or contribute to team meetings

This is a challenging role that takes an ability to thoroughly review, analyze and research complex health care claims in order to identify discrepancies, verify pricing, confirm prior authorizations and process them for payment. You’ll need to be comfortable navigating across various computer systems to locate critical information. Attention to detail is critical to ensure accuracy which will ensure timely processing of the member's claim.

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 higher) OR equivalent years of work experience

  • 3+ years of experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools

  • 1+ years of experience processing medical, dental, prescription, mental health claims & specialty Processor Experience processing High Dollar, non-urn, and Medicaid claims using COMET/UNET/ISET/Host ORS

  • Experience working with Aged Inventory Report Analysis

  • Experience utilizing the Microsoft Office Suite, including Microsoft Excel (use and set up spreadsheets and present data), Microsoft Word (create and edit documents), Microsoft PowerPoint (creating / editing slideshows and presentations)

  • Ability to work any of our 8-hour shift schedules during our normal business hours of (6:00am - 6:00pm CST)

Telecommuting Requirements:

  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy

  • Ability to keep all company sensitive documents secure (if applicable)

  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Preferred Qualifications:

  • OJT New Hire Class/Back-up Subject Matter Expert (SME)

  • TEAMS small group training

  • Experience with SharePoint (software management)

Soft Skills:

  • Analytical thinking and teamwork skills

  • Excellent time management and organizational skills

  • Ability to work autonomously with minimal direction

  • Must possess strong verbal and written communication skills along with the ability to work with a diverse group of people/disciplines at all levels of the organization

  • Must have the ability to multitask, meet tight deadlines, and problem solve in a fast paced environment

  • Experience reading and interpreting job aids (all SPIs)

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at https://uhg.hr/transitioning-military

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet

Making claims a positive experience for our members can drive your sense of impact and purpose. Join us as we improve the lives of millions. Learn more about how you can start doing your life’s best work. SM

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 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. SM

Colorado Residents Only: The hourly range for Colorado residents is $17.12 to $30.34. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

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.

Keywords: work at home, work from home, WAH, WFH, remote, telecommute, hiring immediately, #RPO

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