Associate Claims Representative, United Health Group - Charleston

Responsibilities

• Review, research, solve and process assigned work. This would include navigating multiple computer systems and platforms (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)
• Independently complete on a daily basis all documentation and communicate the status of claims as needed adhering to all 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 established for the position in the areas of quality, production and attendance

Requirements: 

• An education level of at least a high school diploma or GED OR equivalent years of work experience
• Proficiency with Windows PC applications, which includes the ability to navigate multiple programs and learn new and complex computer system applications

For more information, click here

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