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

**Optum** is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start **Caring. Connecting. Growing together.**

This position is full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 6:00am – 3:30pm PST. It may be necessary, given the business need, to work occasional overtime.

We offer weeks of on-the-job training. The hours during training will be 8:30am - 5:30pm PST, Monday – Friday.

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

**Primary Responsibilities:**

+ Accurately process professional claims.

+ Responsible for editing and adjusting of claims per the EDI daily audit report.

+ Analyze and adjudicate claims to ensure accurate payment

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

+ Review claims on a periodic basis

+ Meet Department Quality of 98.50% or better on a weekly and monthly basis. Meet production standard of 350 claims per day.

+ Interfaces with other departments such as eligibility, UM, Configuration 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.

**Required Qualifications:**

+ High School Diploma / GED OR equivalent experience

+ 1+ years of experience processing professional medical Insurance claims

+ Experience using windows based programs including Microsoft Word, Microsoft Excel and Microsoft Outlook

+ Must be 18 years of age OR older

+ Ability to work full-time between 6:00am – 3:30pm PST including the flexibility to work occasional overtime given the business need

**Preferred Qualifications:**

+ 2+ years of experience as a Medical Claims Examiner.

+ 2+ years of experience of professional claims processing.

+ Prior Medicare, HMO experience

+ CPT and HCPCS coding skills.

+ Experience in contract interpretation.

+ Working knowledge of Medical Terminology, ICD9, ICD10, CPT4, UB92/1500 forms.

**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.

**California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington or Rhode Island Residents Only:** The hourly range for California / Colorado / Connecticut / Hawaii / Nevada / New York / New Jersey / Washington / Rhode Island residents is $16.54 - $32.55 per hour. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

_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._

**\#RPO**