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Surest (formerly Bind) Claim Policy and Procedure Specialist - National Remote

Company: UnitedHealth Group
Location: Oldsmar
Posted on: March 16, 2023

Job Description:

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

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

This position is full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm EST or CST. It may be necessary, given the business need, to work occasional overtime.

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

Primary Responsibilities:

  • Participate in the implementation and management of claim operational strategies, policies, workflow processes and standards and ensure effective utilization of them.
  • Function as a liaison to service vendors and business partners to align service delivery with strategic objectives and priorities; Assist in handling escalated service issues
  • Assist with the management of the Claim Processing Team by handling escalated claims processing and benefit configuration questions
  • Assist with the management of complex claims issues such as coordination of benefits and adjustments
  • Assist with the management of complex overpayments and refund processes including auto recoupment of overpayments
  • Assist with the management of the Prior Authorization process with Network Partners
  • Participate in the development of the claims organizational structure. Assist with training claims examiners on the unique Bind plan design
  • Assist with testing and auditing benefit setup and enhancements in the claims adjudication system.
  • Perform special projects as defined by Leader
    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)
    • 5+ years of medical claims experience in a health insurance company environment
    • Experience creating and documenting claim policies and procedures
    • Knowledge of complex claim issues including claim adjustments, refunds and coordination of benefits
    • Ability to work full-time between 8:00am - 5:00pm EST or CST including the flexibility to work occasional overtime given the business need
      Preferred Qualifications:
      • Bachelor's degree (or higher) in business, insurance, healthcare administration, nursing, OR a related field
      • Experience in automating and/or re-engineering manual claim processes
      • Claim technology expertise and workflow management including electronic claim files and CARC/RARC mapping
      • Experience working as a liaison between operational departments and/or technical team
      • Experience with Microsoft Visio, Word, Excel, and PowerPoint
      • Experience in a healthcare environment with HIPAA requirements
      • Previous claims processing experience: lead or supervisor level
        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
          Soft Skills:
          • Excellent project management skills, with ability to manage multiple priorities with tight deadlines, and demonstrated strong problem-solving skills and attention to detail
          • Excellent analytical skills with ability to read and understand complex data and make thoughtful, articulate recommendations; ability to translate analysis of data into meaningful outputs
          • Ability to influence course of action when others are directly accountable for outcomes
            Careers with UnitedHealthcare. Work with a Fortune 5 organization that's serving millions of people as we transform health care with bold ideas. Bring your energy for driving change for the better. Help us improve health access and outcomes for everyone, as we work to advance health equity, connecting people with the care they need to feel their best. As an industry leader, our commitment to improving lives is second to none.

            California, Colorado, Connecticut, Nevada, Washington or New York, Rhode Island Residents Only: The salary range for California / Colorado / Connecticut / Nevada / Washington / New York / Rhode Island residents is $27.07 - $53.08. 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.

            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.

Keywords: UnitedHealth Group, Tampa , Surest (formerly Bind) Claim Policy and Procedure Specialist - National Remote, Other , Oldsmar, Florida

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