Claims Clerk - Cypress, CA

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The Claims Clerk is responsible for providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims.

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). It may be necessary, given the business need, to work occasional overtime. Our office is located at 6601 Center Drive West , LOS ANGELES, CA 90045.

Primary Responsibilities:

• Provide general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims.
• Authorize the appropriate payment or refers claims to investigators for further review.
• Conduct data entry and re-work; analyzes and identifies trends and provides reports as necessary.
• Analyze and identify trends and provide reports as necessary
• Consistently meet established productivity, schedule adherence, and quality standards
• Recognize claims by determining claim type - HCFA, Hospital, UB, and/or RX
• Identify more complicated claims and refer them to Senior Claim Processor or Supervisor
• Calculate other insurance and re-pricing benefits
• Work claims files to ensure the appropriate eligibility and provider records are matched to the claim
• Updates and maintains claims tracking database

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)
• 1+ years of experience in an office setting environment using the telephone and computer as the primary instruments to perform job duties
• Basic proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
• 2+ years of data entry experience
• Basic understanding of healthcare claims including ICD-9 and CPT codes
• Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance.

Preferred Qualifications:

• 1+ years of experience working with medical claims
• Prior experience working with IDX software
• 1+ years of working in production based environment
• Type 60+ WPM

Soft Skills:

• Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

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Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible.

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 5 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near - obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, Military families and Veterans wherever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work. SM

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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