If you are located within a commutable distance from Irvine, CA, you will have the flexibility to telecommute* (work from home) as you take on some tough challenges.

This is an opportunity that’s all about where you’ve been. Your experience. Your potential. Your skills. Because on the team at UnitedHealth Group , your potential and your impact can be career changing. No company has put together better teams of passionate, energetic and all out brilliant Claims Representatives . This is where you come in. We’ll look for your experience and expertise to help keep our service levels and accuracy extremely high. We’ll also look for your ideas on how to constantly evolve our claims processes. We’ll back you with the great training, support and opportunities you’d expect from a Fortune 5 company leader.

This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of ( 7:30am-4:00pm Pacific Time ). It may be necessary, given the business need, to work occasional overtime. Our office is located at 2300 Main St Irvine, CA .

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

• Assist with escalated claims to resolve complex issues for team members and internal customers
• Support implementation of updates to the current procedures and assist with new system training/mentoring
• Review guidelines as well as benefit plan documents and certificates to ensure proper benefits have been applied to each claim
• Analyze and identify trends and provides reports as necessary

This is a challenging role that takes an ability to thoroughly review, analyze and research complex health care claims in order to identify discrepancies, verify pricing, confirm prior authorizations and process them for payment. You’ll need to be comfortable navigating across various computer systems to locate critical information. Attention to detail is critical to ensure accuracy which will ensure timely processing of the member's claim.

Making claims a positive experience for our members can drive your sense of impact and purpose. Join us as we improve the lives of millions. Learn more about how you can start doing your life’s best work. SM

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 higher) OR 2+ years of equivalent work experience
• 3+ years of experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools
• 1+ years of experience processing medical, dental, prescription or mental health claims
• Proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
• Ability to work from 7:30am - 4:00pm Pacific Time, Monday to Friday including the flexibility to work occasional overtime and weekends as the business need

Telecommuting Requirements:

• Reside within a commutable distance from Irvine, CA
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Ability to keep all company sensitive documents secure (if applicable)
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
  

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies required all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with Optum . Our objective is to make health care simpler and more effective for everyone. With our hands at work across all aspects of health, you can play a role in creating a healthier world, one insight, one connection and one person at a time. We bring together some of the greatest minds and ideas to take health care to its fullest potential, promoting health equity and accessibility. Work with diverse, engaged and high-performing teams to help solve important challenges.

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.

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