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Job Category:ClaimsReference Code:315643Position Type:Full-time, Regular UnitedHealth Group is among the most ambitious Fortune 25 companies you'll ever meet. Through our family of businesses, we're working to make the health care system perform better for more people, in more ways than ever.Simply put, we think the entire system can be greater than it's ever been. And that drives us to work harder, aim higher, and expect more from one another.Here, you'll be empowered to make an immediate impact for millions of others. And you'll achieve more than you ever expected. How does that fit with your plans? Claims Representative Associate - San Diego, CA-315643UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.DescriptionOptumHealth is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. If you want more meaning in your career - as a clinician or a business professional - think of OptumHealth as your calling. By providing 60 million Americans with information, tools and solutions, we are helping to guide them through the health care system, financing their health care needs, and enabling them to achieve their personal health and well-being goals. Position Description: Responsible for documenting, responding to and resolving provider calls on issues related to claims payments, benefits and eligibility and authorization issues. Primary Responsibilities: Respond to telephone inquiries and written correspondence from members and providers related to claims payments, benefits and eligibility, and authorization issues Investigate issues and documents steps to achieve resolution Manage resolution of issues through contact with UBH Claims Department, Utilization Management, and external payers to achieve a positive outcome to the issues Investigate and handle retro-authorization activities, as required for resolution Respond to providers inquiries regarding the status of formal complaints or appeals Maintains accountability for total problem resolution and communicates resolution to appropriate parties Assist with special projects and perform other duties as assigned Position requires access to electronic application and documents which include Individually Identifiable Health Information and Personal Health Information At OptumHealth, you will perform within an innovative culture that's focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact that's greater than you've ever imagined.Qualifications Qualifications: High school or equivalent experience required; some college preferred 2 - 3 years customer service experience required 2 - 3 years knowledge of CRT and phones and typing experience required Member/provider service experience in an insurance or HMO environment preferred Claims processing experience strongly desired Insurance experience preferred Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V UnitedHealth Group is a drug-free workplace. All candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing. Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V. UnitedHealth Group is a drug-free workplace. Candidates are requir