Medical Claims Representative Associate - Las Vegas, NV

At UnitedHealthcare , we’re simplifying the health care experience, creating healthier communities, and removing barriers to quality care.

The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable.

Ready to make a difference? Join us and start doing your life’s best work.SM

The Medical Claims Representative Associate works under minimal supervision adjudicating routine to complex claims. They release designated pending claims to achieve established production, quality, and cycle time standards in accordance with EOC, Benefit Schedules and contractual arrangements.

They monitor and report desk inventory notifying management of problem identification.

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 6 : 00 AM - 5 : 00 PM.

Alternate schedules are available for those who would prefer to work four 10-hour shifts from Monday - Friday as long as employees are working the hours per business need.

It may be necessary, given the business need, to work occasional overtime.

Our office is located at N Tenaya Way, Las Vegas, NV, .

We offer up to 4-6 weeks of paid training. The hours of training are Monday - Friday, 7 : 00am-3 : 30pm PST. Training will be conducted on - site.

Primary Responsibilities :

• Adjudication of claims to quality and production standards applicable to this position.
• Monitor work inventory and submit non-I Max sheets completed accurately by first day of each month.
• Analyze medical claims to ensure accurate claims adjudication.Claims processing in accordance with EOC, Benefit Schedules and Provider Contracts.
• Release by deadline to meet Company, state regulations, contractual agreements and group performance standards.
• Problem identification and reporting to management.
• Resolution of priority projects.
• Performs all job functions with a high degree of discretion and confidentiality in compliance with federal, SHS and departmental confidentiality guidelines.

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 years of work experience
• 6+ months previous experience in Medical / Dental insurance, office or medical billing setting
• 6+ months experience with Medical terminology, ICD-10, or CPT coding with an understanding of Insurance Certificates, Benefit Schedules, Provider / Group Contracts and Standard Insurance Industry Practices.
• Must be 18 years of age or older.
• Ability to work 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 6 : 00 AM - 5 : 00 PM.

Alternate schedules are available for those who would prefer to work four 10-hour shifts from Monday - Friday as long as employees are working the hours per business need.

It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications :

1+ years medical claims processing experience working with HMO / PPO or indemnity claims.

Soft Skills

• Must possess understanding of basic mathematics.
• Demonstrated knowledge of or ability to learn and apply to job functions, those federal and state laws and regulations applicable to the operating unit.

Nevada Residents Only : The hourly range for this is $16.00 - $28.27 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc.

UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and k 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 #RED