Professional Claims Examiner - Ontario, CA

UnitedHealth Group US

Job Description

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.(sm)

Primary Responsibilities:

  • Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims

  • Authorize appropriate payment or refer claims to leads or supervisors for further review

  • Analyze and identify trends and provides reports as necessary

  • Consistently meet established productivity, schedule adherence, and quality standards

  • Provide excellent customer service

  • Accurately process professional claims

  • Responsible for editing and adjusting of EDI claims

  • Analyze and adjudicate claims to ensure accurate payment

  • Interpret Fee for Service (FFS) and capitated provider contracts

  • Interfaces with other departments to obtain necessary information required for resolution of claims

  • Advise management of any claim issues or inappropriate and/or incorrect billing

  • Other duties assigned by management

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.

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