You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
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
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, 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.
- 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
- Process dental claims which cannot be cleanly adjudicated by the claims processing system.
- 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
- Point of contact for internal departments to answer questions relative to member claims
- Work with the leadership team to resolve issues as needed
- Ability to communicate complex program criteria into easily understood summaries in both oral and written communication
- Validation of claim coverage in relation to program guidelines
- Compete activities and reporting as required by the fraud, waste, and abuse plan
- Investigating, recovering, and resolving all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities.
- Initiating telephone calls to members, providers, and other insurance companies to gather coordination of benefits data.
- Investigate and pursue recoveries and payables on subrogation claims and file management.
- Process recovery on claims.
- Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance. May conduct contestable investigations to review medical history.
- Monitor large claims including transplant cases.
- Extensive work experience, possibly in multiple functions.
- Work does not usually require established procedures.
- Works independently.
- Mentor’s others.
- Acts as a resource for others
- Coordinates others' activities
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.
- High School Diploma / GED (or higher)
- Experience processing dental claims or other medical claims
- Ability to work an 8-hour shift between the hours 8:00am - 4:30pm, CST, Monday – Friday
- Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state, and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance.
- Working knowledge of health insurance claims OR patient financial services OR Revenue Cycle experience (similar experience may be considered)
- 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 https://uhg.hr/transitioning-military
Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet
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, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $17.12 to $30.34. The salary range for Connecticut / Nevada residents is $18.80 to $33.41. 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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