Claims Representative - San Juan, PR
San Juan, PRFull-timeSeen 1 day agoSeen in employer's feed 1 day ago
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Job overview
The Claims Representative processes claims, authorizes appropriate payments, and refers claims for further investigation when needed. The role handles a range of claim types and escalations, works across functions and applications, and communicates inventory, volume, and quality trends. Candidates need production-environment experience, computer proficiency, and verbal and written English proficiency. Medical billing, claims, and healthcare experience are preferred.
Skills & qualifications
Skills
Qualifications
Full job description
Requisition number: 2400717
Job category: Claims
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.
Primary Responsibilities:
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Authorizes the appropriate payment or refers claims to investigators for further review
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Conducts data entry and claims processing/issues
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Responsible for handling issues within turnaround standards
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Ability to handle most claim types / cases / issues that are submitted to the team you are supporting
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Ability handle escalations as needed
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Ability to work multiple functions and applications in a day as needed
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Communicate any changes in trending of inventory, volumes, and quality remediation
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Complete required individual development courses / training
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Meet and maintain minimum quality and productivity standards
***** ENGLISH PROFICIENT ASSESSMENT WILL BE REQUIRED AFTER APPLICATION *****
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:
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1+ years of experience in a production environment
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Proficient in MS Office with solid computer skills (e.g. multiple systems experience, keyboarding skills, Microsoft word, Power Point)
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Proficient in verbal and written English skills
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Ability to work 40 hours / week during standard business operating hours Monday - Friday from 7am - 7pm AST (It may be necessary, given the business need, to work occasional overtime on weekends and holidays)
Preferred Qualifications:
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Experience in medical billing or claims
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Healthcare experience
At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.
UnitedHealth Group and its affiliated brands are 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 and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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