Claims Associate - Cincinnati, OH

UnitedHealth 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.



UnitedHealthcare, a UnitedHealth Group company, provides network-based health and well-being benefits and services for employers and consumers nationwide. We use our strength, diversity and innovation to improve the lives of the more than 18 million people who receive our unique products and services. And our endless pursuit for excellence in everything we do extends to your career as well. Join us today for an inspired and purposeful mix of professional growth opportunities and personal rewards.





Job Responsibilities:




Responsible for the accurate processing and completion of medical claims upon first receipt.




Process basic types of medical claims within current turnaround standards.




Process basic correspondence (e.g., student status, employment updates).




Process same day voids and reconsiderations (e.g., denied, change of medial authorization).




Proficiency in product lines instructed in classroom training.




Ability to understand and apply plan concepts to include: COB, deductible / co - insurance co - pay, out of pocket / lifetime maximums.




Ability to process complex claims which includes:




UHG product knowledge including standard plan components (benefits) applicable to the service center.




Office Specific Product knowledge including plan components (benefits). UNET System(s) and Workflow knowledge (Electronic-EDI, Keying Vendors, UFE, CES, EPD, Front End, Claim Routing, TOPS / UNET, Claim Queues, Summary Check).




Standard Claim Processing, Policy, Procedures, Processes knowledge and Claim Processing policy / procedure / process reference material/resources knowledge.




Process to completion co - pay claims.




Process to completion claims with eligibility discrepancies.




Process to completion claims with coding discrepancies (Pend, remark, diagnosis, service, cause, override, Place of Service, attachment and denial / closure codes).




Process to completion claims requiring internal/national routing.




Process to completion claims requiring same day void, stop payment, and / or delete before issue transaction.




Access systems (e.g., ACIS, iBAAG, EBDS, TDARS and Preference) to obtain information that will assist in claim resolution.




Special projects as required.




Adhere to quality improvement initiatives.




Access Lotus Notes for incoming mail and respond to inquiries.




Respond to an inquiry on PC - ORS.


Job Requirements:

Job Qualifications:

High school diploma or equivalency.

PC skills (Word / Excel).

Attention to detail.

Quality focused.

Decision making skills.

Organizational skills.

Problem solving.

Team player.


Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V.