You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.Positions in this function are responsible for providing expertise or general support to teams in reviewing, researching, investigating, negotiating and resolving all types of appeals and grievances. Communicates with appropriate parties regarding appeals and grievance issues, implications and decisions. Analyzes and identifies trends for all appeals and grievances. May research and resolve written Department of Insurance complaints and complex or multi-issue provider complaints submitted by consumers and physicians / providers. Employees in jobs labeled with ‘SCA’ must support a government Service Contract Act (SCA) agreement.This position is full-time, Monday - Friday. Employees are required to work any 8-hour shift between the hours of 6:00 AM - 5:30 PM CST including the flexibility to work occasional overtime and weekends based on business need.This will be on-the-job training. The hours during training will be 8:00 AM - 4:30 PM CST from Monday - Friday. Training will be conducted virtually from your home.All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.Primary Responsibilities:
Review and approve provider claims in an accurate, efficient, and timely manner to maintain good working relationships between Optum Serve and network providers
Match claims received to Optum Serve orders, verify amount billed versus contracted rates, review order status, and review provider fee schedules for confirmation of rates and terms
Investigate any discrepancies, balance forwards, or aged claims, and communicate with providers to resolve the issue
Field incoming calls from providers and internal departments to provide payment details, explanation of payment, and more
Determine if follow up communication is needed
Understand Optum Serve contracts and terms to ensure timely and accurate payments to providers
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 work experience
Must be 18 years of age OR older
1+ years of related accounting experience (equivalent combination of education, experience, and applicable military experience will be considered)
Knowledge of accounting and accounts payable procedures and practices
Ability to work any 8-hour shift between the hours of 6:00 AM - 5:30 PM CST including the flexibility to work occasional overtime and weekends based on business need
Preferred Qualifications:
National Career Readiness Certificate
Knowledge of medical and dental terminology
Accounting system experience and database experience
Telecommuting Requirements:
Ability to keep all company sensitive documents secure (if applicable)
Required to have a dedicated work area established that is separated from other living areas and provides information privacy
Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
Soft Skills:
Oral and written communications skills
Proven data entry and organization skills as well as accuracy, attention to detail, and the ability to work in a team oriented environment
Ability to handle corporate documents confidentially
Demonstrated analytical competencies
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington, Rhode Island, OR Washington, D.C. Residents Only: The hourly range for this is $16.54 - $32.55 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. 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. 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 .#RPO