Medical Claims Examiner - La Palma, CA

    • Cerritos, CA

Position Description
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 6 leader.

To process the medical claims of AppleCare's IPA clients pursuant to designated production quotas for accuracy and productivity benchmarks. Our production quotas are a minimum of 175 IPA claims per day.

We are offering a $500 sign on bonus for external candidates .

Primary Responsibilities:

  • Batch and prioritize a minimum of 175 IPA claims processing per day utilizing the company's in-house claims processing system
  • Verify patient's accounts for eligibility and benefits
  • Process complex claims that have been accepted for payment
  • Request and follow-up on additional information as needed for incomplete claims
  • Complete all steps above within designated timeframes (production quotas) and notify management if claims cannot be processed within the designated time frame
  • Assemble denial letter background information and generate denial letters
  • Read, interpret and summarize medical contracts/division of responsibility before allowance of payments
  • Identify claims that are not our financial risk and forward to appropriate entity for payment
  • Review claims that are pending and follows through for payment in a timely manner
  • Works with various fee schedules (i.e., CMS, Medical)
  • Treat peers, superiors, subordinates clients and vendors with fairness, courtesy and professionalism and contribute to the overall positive work environment of the department
  • Complete other production projects as assigned

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 graduate
  • Requires 2+ years' experience working as an actual "Claims Examiner" in a Managed Care environment (Billing experience is not considered)
  • 2 years of experience working with various fee schedules (i.e., CMS, Medical, etc.)
  • Strong proficiency with computer and Windows PC applications, which includes the ability to learn new computer system applications

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)

AppleCare Medical Group was formed in Lynwood, California in 1996 with the goal of making quality care available locally to the community. Today, AppleCare Medical Group is comprised of hundreds of board-certified private-practice, independent physicians. These physicians provide medical expertise and passion to improving the health of communities in the Southeast area of Los Angeles and Northern Orange County.

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

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

Job Keywords: Claims examiner, IPA, Managed Care, professional claims, denial process, compliance, healthplans, medical claims, CMS, DHMC, La Palma, CA, California

With offices around the world, UnitedHealth Group's headquarters are located in the Minneapolis metropolitan area.

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