Medical Claims Investigator - Remote

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

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work. SM

The Medical Claims Investigator will work with a team on researching issues to determine feasibility of reducing medical costs through prospective solutions of claim system processes and claim business rules.

This position is full - time (40 hours / week), Monday - Friday. Employees are required to work our normal business hours of 8:00 AM - 5:00 PM. It may be necessary, given the business need, to work occasional overtime or weekends.

We offer 3 weeks of training. The hours during training will be 8:30 AM - 6:00 PM EST. Training will be conducted virtually from your home.

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

Primary Responsibilities:

• Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization
• Investigate, recover, and resolve all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities
• Investigate and pursue recoveries and payables on subrogation claims and file management
• Initiate phone calls to members, providers, and other insurance companies to gather coordination of benefits information
• Process payment on claims
• Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
• Use pertinent data and facts to identify and solve a range of problems within area of expertise

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)
• 2+ years of experience with claims auditing and researching claims information
• 1+ years of experience with analyzing data and identify cost saving opportunities
• Experience in working with medical claims platforms
• Knowledge of claims processing systems and guidelines / processes
• Intermediate skills with Microsoft Excel (create, edit, sort, filter, pivot tables)
• Experience in healthcare
• Coder Certification (CPC OR CCS OR equivalent)
• Ability to work any 8-hour shift between the hours of 8:00 AM - 5:00 PM

Preferred Qualifications:

• Bachelor's Degree (or higher)
• 1+ years of project management experience
• Knowledge of Medicaid / Medicare Reimbursement methodologies
• Microsoft Access (create, edit, format, manipulate data)

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

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work. SM

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $25.63 to $45.72. The salary range for Connecticut / Nevada residents is $28.27 to $50.29. 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.

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.

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