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| Senior Claims Representative - Irvine, CA |
Job Location:
Metro Area: |
Irvine, CA
CA - Los Angeles
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Category: |
Customer Service
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Contact Info |
Company Name: UnitedHealth Group
Website:
Click to Visit
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Apply: Submit Resume Now
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Job Description:
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Prescription Solutions is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
If you're ready to talk about groundbreaking interactions, let's talk about what happens when a firm that touches millions of lives decides to gather results from millions of prescriptions every month and analyze their impact. Let's talk about smart, motivated pharmacy teams. Let's talk about more effective and affordable health care solutions. This is caring. This is great chemistry. This is the way to make a difference.
The Claims Administration Department is looking for a self-motivated individually who shares our work ethic to join us in this key role.. Bring your claims expertise to a world-renowned Fortune 50 Company, where innovation and career growth are encouraged...apply today.
Senior Claims Representative - Irvine, CA
Primary Responsibilities:
- Reprocessing claims
- Reviewing Data outcome
- Resolving claim adjudication rejections from the reprocess claims
- Contacting Pharmacies for reversing and processing claims
- Keying data entry corrections
- Conducting basic research to clarify information
- Assisting with COB (coordination of benefits) as needed
- Performing MODS testing
- Collaborating with other departments to resolve data issues, opening and closing processing windows
- Assisting CMS Reporting
Prescription Solutions is an empowering place for people with the flexibility to help create change. Innovation is part of the job description. New ideas are welcome. And passion for improving the lives of our customers is a motivating factor in everything that happens.
 Required Skills: Qualifications:
- 2 years of Healthcare Pharmacy experience required
- Experience working with MS Word and Excel required
- PBM experience preferred
- Processing pharmacy claims or related pharmacy experience is also preferred
- Any experience in the healthcare field is a plus
- Excellent communication skills
- Excellent communication skills and a strong work ethic are key
- Applies knowledge/skills to complex activities
- Demonstrates a depth and breadth of knowledge/skills in own area and is often able to apply these outside of own function
- Often acts as a technical resource to others in own function
- Anticipates customer needs and proactively identifies solutions
- Solves complex problems on own; proactively identifies new solutions to problems
- Plans, prioritizes, organizes and completes work to meet established objectives
- Acts as a facilitator to resolve conflicts on team; seen as key team member on project teams spanning more than own function
- High school education or equivalent experience
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
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