Role Description

This position is National Remote. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

A Medical Claims Analyst (MCA) is responsible for the intake processing and triage of all initial claim documents in a high-volume environment. This includes but is not limited to:

• Referral processing
• Obtaining required documents
• Medical records sorting and processing
• Preparing payment calculations
• Preparing the claim for a Nurse review
• Applying all Nurse findings to the claim
• Preparing and sending reports
• Preparing and sending provider packets

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 8:00am – 5:00pm MST. It may be necessary, given the business need, to work occasional overtime.

We offer 4 weeks of on-the-job training. The hours of training will be aligned with your schedule.

Primary Responsibilities:

• Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims
• Analyze and identify trends and provide reports as necessary
• Consistently meet established productivity, schedule adherence and quality standards

This is a challenging role that takes an ability to thoroughly review, analyze and research complex healthcare 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 support timely processing of the member's claim.

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.

Qualifications

• High School Diploma / GED OR equivalent years of work experience
• Must be 18 years of age OR older
• 1+ years of experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools
• Proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
• Experience with Microsoft Word (create correspondence and work within templates) and Microsoft Outlook (email and calendar management)
• Intermediate experience with Microsoft Excel (Sorting and filtering data, using formulas, and working with Tables)
• Ability to work Monday – Friday, 08:00AM – 05:00PM MST

Requirements

• Familiarity with UB04’s
• 1+ years of experience processing medical, dental, prescription or mental health claims
• 1+ year of experience processing insurance claims or billing/collections in a healthcare or commercial setting
• Understand and maintain HIPAA confidentiality and privacy standards when completing assigned work

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

• Attention to detail

Benefits

• Comprehensive benefits package
• Incentive and recognition programs
• Equity stock purchase
• 401k contribution (all benefits are subject to eligibility requirements)

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.