LHI Claims Resolution Specialist II - Remote

At Optum, the mission is clear: Help people live heathier lives and help make the health system work better for everyone

LHI is one of 4 businesses under OptumServe. OptumServe provides health care services and proven expertise to help federal government agencies modernize the U.S. health system and improve the health and well - being of Americans.

By joining OptumServe you are part of the family of companies that make UnitedHealth Group a leader across most major segments in the U.S. health care system.

LHI was founded in 1999 and acquired by Optum in 2011, LHI specializes in creating and managing health care programs through on - location services, patient - specific in - clinic appointments, telehealth assessments, or any combination based on customer need. LHI's customizable solutions serve the diverse needs of commercial customers, as well as federal and state agencies, including the U.S. Departments of Defense, Veterans Affairs, and Health and Human Services.

There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Ready for a new path? Start doing your life's best work. SM

The LHI - Claims Resolution Specialist II will assess and coordinate claims inquiries for a very diverse population of members of the World Trade Center (WTC) Health Program Nationwide Provider Network throughout the United States. Educate and inform members of program coverage and limitations for claims within contract requirements. Use critical thinking, research and problem - solving skills to navigate through the complexities of a member's health certification and their respective medical claims while maintaining coverage within the program guidelines.

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 - 4:30pm. It may be necessary, given the business need, to work occasional overtime.

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

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

Primary Responsibilities:

• Maintain an ongoing responsibility for assigned claims inquiries which entails assessment, education and coordination for members / health care providers throughout the United States via telephone while keeping a detailed record within the internal database. Establish and maintain positive relationships with members, providers and our claims contractors.
• Manage inbound and outbound calls from providers and members to resolve claims issues.
• Request and manage medical records to help determine potential program coverage and communicate results to the members.
• Completion of system generated tasks, including documenting all results as required.
• Prepare comprehensive reviews and summaries for claims appeals.
• Point of contact for internal departments to answer questions relative to member claims.
• Work with the leadership team to resolve issues as needed.
• Able to handle emotionally charged phone calls and ability to deliver unfavorable claims outcomes.
• Ability to communicate complex program criteria into easily understood summaries in both oral & written communication.
• Validation of claim coverage in relation to program guidelines.
• Compete activities and reporting as required by the fraud, waste and abuse plan.
• Monitor progress of Accounts Receivable targets and plans within contract KPI's
• Performs periodic and month - end balancing and reporting activities
• Perform research / verification of identified claims to identify payment / overpayment issues / accuracy
• Work with payers / providers to review claim information and identify issues related to payment accuracy
• Document and communicate outcomes of claims investigations / overpayment reviews to applicable stakeholders

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)
• One of the following:
  • 2+ years of experience working with health insurance claims
  • Medical coding/medical claims processing experience
  • Similar background/experience in healthcare (CMA, MA, etc).
• If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking orders

Telecommuting Requirements:

• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Ability to keep all company sensitive documents secure (if applicable)
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Preferred Qualifications

• Experience and knowledge of Medical Claims, Medicare / Medicaid guidelines
• Working knowledge of Medical Terminology
• Proficient in Microsoft Office Suite including Word (create, edit, save), Excel (create, edit, save), and Outlook (send & receive emails)

Soft Skills:

• Able to handle emotionally charged phone calls and ability to deliver unfavorable claims outcome.
• Ability to communicate effectively both verbally and in writing
• Strong organization, planning, interpersonal and multi - tasking skills
• Must be a self - starter and comfortable with confidential information
• Attention to detail, strong problem - solving and time - management skills
• Ability to work in a fast - paced environment, flexible and adaptable to changing situations, and a strong commitment to teamwork
• Proven skills to establish rapport, trust and confidence with internal departments, staff and external vendors
• Ability to remain calm in stressful situations and to conduct themselves in a professional manner at all times
• Must be able to identify and define problems; collect data; establish facts and draw valid conclusions

UnitedHealth Group is an essential business. The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. At this time, 90% of our non - clinical workforce transitioned to a work at home (remote) status. We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us. You can learn more about all we are doing to fight COVID-19 and support impacted communities at:

Careers with LHI. Our focus is simple. We're innovators in cost-effective health care management. And when you join our team, you'll be a partner in impacting the lives of our customers, and employees. We've joined OptumHealth, part of the UnitedHealth Group family of companies, and our mission is to help the health system work better for everyone. We're located on the banks of the beautiful Mississippi River in La Crosse, Wis., with a satellite office in Chicago and remote employees throughout the United States. We're supported by a national network of more than 25,000 medical and dental providers. Simply put, together we work toward a healthier tomorrow for everyone. Our team members are selected for their dedication and mission-driven focus. For you, that means one incredible team and a singular opportunity to do your life's best work. SM

Colorado Residents Only: The salary range for Colorado residents is $17.12 to $30.34. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

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.
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