Claims Examiner Lead (Healthcare) - Ontario, CA (868349)
UnitedHealth Group
Ontario, CA
6d ago

Position Description

Welcome to one of the toughest andmost fulfilling ways to help people, including yourself. We offer the latesttools, most intensive training program in the industry and nearly limitlessopportunities for advancement.

Join us and start doing your life's bestwork.(sm)

Primary Responsibilities :

Responsible for monitoring andtracking the employee’s daily productivity through various reports

Provides daily direction andcommunication to employees

Responsible for establishing workprocedures that support the departmental standards procedures, and strategicdirectives

Troubleshoots claims to ensureaccurate payment

Provides statistical and performancefeedback and coaching on a regular basis to each team member

  • Insure employees have appropriatetraining and other resources to perform their jobs. Respond to and assistmanager in resolving employee relation issues expressed by team members;
  • createand maintain high quality work environment so team members are motivated toperform at their highest level

    Use appropriate judgment in upwardcommunication regarding department or employee concerns

    Work as a member / leader of specialor on-going projects that are important to area / process improvement

    Responsible for making suggestionsas to how the claims process system can be improved

    Informs claims staff of any changesto Provider and Healthplan contracts

    Be available for employees thatexperience difficulty in troubleshooting claims

    Takes provider calls on difficultissues regarding claims

    You’ll berewarded and recognized for your performance in an environment that willchallenge you and give you clear direction on what it takes to succeed in yourrole as well as provide development for other roles you may be interested in.

    RequiredQualifications :

    An education level of at least ahigh school diploma

    Requires 2+ solid years’ continuous experienceworking as a Healthcare / Medical Claims Examiner . (Billing of Claims does not pertainto this position.)

    Strong proficiency with computer andWindows PC applications, which includes the ability to learn new and complexcomputer system applications

    PreferredQualifications :

    Experience working on claims in a ManagedCare setting

    Prior Medicare, HMO and Auditingexp. preferred

    Working knowledge of medicalterminology, ICD9, CPT4, UB92, 1500 Form and FFS contract interpretations

    Revenue and HCPCS coding skills preferred

    Team Lead experience highlypreferred

    Ability to multi-task, this includesability to understand multiple products and multiple levels of benefits withineach product

    Demonstrates excellent interpersonalskills as discerned through observation and team project successes.

    Accurately interprets and appliesdepartmental policies and procedures using sound judgment as is related toclaims processing.

    Communicates clearly, professionallyand respectfully to peers, superiors, subordinates and clients.

    Meets production quota for bothinput levels and accuracy on a weekly basis as set forth by the departmentstandards

    Efficiently organizes andprioritizes workflow

    Provides constructive feedback onwork projects assigned

    Consistently produces accurate andtimely work product as it relates to departmental goals

    Demonstrates high reliabilitythrough consistent punctuality and attendance

    Demonstrates overall professionalismin attitude, demeanor and personal appearance

    Careerswith Optum . Here's the idea. We built anentire organization around one giant objective; make the health system workbetter for everyone.

    So when it comes to how we use the world's largeaccumulation of health-related information, or guide health and lifestylechoices or manage pharmacy benefits for millions, our first goal is to leapbeyond the status quo and uncover new ways to serve.

    Optum, part of theUnitedHealth Group family of businesses, brings together some of the greatestminds and most advanced ideas on where health care has to go in order to reachits fullest potential.

    For you, that means working on high performance teamsagainst sophisticated challenges that matter. Optum, incredible ideas in oneincredible company and a singular opportunity to do your life's best work.(sm)

    OptumCare is committed to creatingan environment where physicians focus on what they do best : care for theirpatients. To do so, OptumCare provides administrative and business supportservices to both owned and affiliated medical practices which are part ofOptumCare.

    Each medical practice part and their physician employees havecomplete authority with regards to all medical decision-making and patientcare.

    OptumCare’s support services do not interfere with or control thepractice of medicine by the medical practices or any of their physicians.

    Diversity creates a healthier atmosphere : UnitedHealth Groupis an Equal Employment Opportunity / Affirmative Action employer and allqualified applicants will receive consideration for employment without regardto race, color, religion, sex, age, national origin, protected veteran status,disability status, sexual orientation, gender identity or expression, maritalstatus, genetic information, or any other characteristic protected by law.

    OptumCare is a drug-free workplace. Candidates are requiredto pass a drug test before beginning employment.

    JobKeywords : Claims examiner, Managed Care, Team Lead, Medicare, HMO,Auditing, Medical Terminology, ICD9, ICD10, CPT4, UB92, 1500 Form, HCPCS

  • Requisition Number868349
  • Job TitleClaims Examiner Lead (Healthcare) - Ontario, CA
  • Job FamilyClaims
  • Business SegmentOptumCare
  • Job Location Information

    North America

    Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusNon-exempt
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