Position Description: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.The Claims Clerk is responsible for performing clerical activities related to claims processing, inventory tracking, inbound claims reconciliation, refund request / processing, claim intake and other clerical activities to support the Claims Department.Positions in this function are responsible for providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims. Authorizes the appropriate payment or refers claims to investigators for further review. Conducts data entry and re-work; analyzes and identifies trends and provides reports as necessary.Primary Responsibilities:Sends and tracks first and second refund request letters to providersProcesses and tracks provider refunds receivedReviews Customer Service retracts payment requests and process the reversalForwards claims to the health plan for processingPerforms address verification on return mailInterfaces with Provider Relations to research and update mailing address in Eye ManagerProcesses pending lab invoice claimsReviews lab invoice claims with errors and clears for processingData enters paper claimsBack up to Facilities to pick up and distribute mailPerforms Mail Room tasks of opening, sorting, batching, counting, and scanning incoming paper claimsPerforms Mail Room claim inventory control and prepares imaged claims for shredding in accordance with company policyRuns daily inventory reports and creates ticket to Software Development for discrepanciesReports end of the month claims countOther duties as assigned by managementLimited work experienceWorks on simple tasks using established proceduresDepends on others for guidanceWork is typically reviewed by others
Required Qualifications:High School Diploma / GED (or higher)Experience working in claims in a medical or vision settingKnowledgeable of CPT, HCPCS and ICD-10 codingExperience with data entry (10 key with decimals and alphanumeric typing)Physical Requirements and Work Environment:Extended periods of sitting at a computer and use of hands / fingers across keyboard or mouseCareers with MARCH® Vision Care. Now this is a place where you can bring your compassion and desire to innovate. MARCH® Vision Care was built with a groundbreaking platform in mind for delivering quality vision care — one that not only focuses on early disease detection, but also uses state-of-the-art technology to help improve communication between members and their doctors. As part of the UnitedHealth Group family of businesses, we specialize in the administration of vision care benefits for managed care organizations, specifically for government sponsored programs such as Medicaid, Medicare, Medicare-Medicaid Plans, and Healthcare Exchange. Join our team and you'll quickly realize this is the opportunity to do your life's best work. 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: medical claims, healthcare claims, claims representative, claims rep, claims processing, claims processor; UnitedHealth Group, UnitedHealth care, training, classes, MARCH VISION
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.