Claims Service Representative - San Diego, CA

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.



United Behavioral Health, a UnitedHealth Group company, is a leading provider of emotional wellness services. Currently serving over 22 million Americans, our innovative solutions include behavioral health, employee assistance, work/life and pharmacy management services, as well as a unique disability support program. We offer specialized, confidential support to help our members live and work well, and excellent resources and rewards for your career so you can do the same. A healthy business awaits you at UBH.

 

Responsibilities includes:
Documenting / Responding to / Resolving
provider calls on issues related to claims payments, benefits and eligibility and certification issues. 
Responding to telephone inquiries and/or written correspondence from members and/or providers related to:
claims payments, benefits and eligibility, and certification issues. 
Investigating issues and documenting steps to achieve resolution. 
Managing resolution of issues through contact with UBH claims department, case management, and external payers to achieve a positive outcome to the issues. 
Investigating and handling retrocertification activities as required for resolution. 
Responding to providers regarding the status of formal complaints or appeals. 
Maintaining accountability for total problem resolution and communicating resolution to appropriate parties. 
All other duties as deemed appropriate to provide customer service. 
Position requires access to the following electronic applications which include Protected Health Information (PHI):
eCura (4A Claims Support Staff)
InSyst (Claims Examiner)
ORBIT



Requirements:
2-3 years customer service experience.
Member/provider service experience in an insurance or HMO environment.
Claims processing experience strongly desired.
Knowledge of CRT and phones and typing experience.
Ability to work independently and prioritize workflow. 

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