Key Responsibilities
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Process, review, and triage initial medical claim documents in a high-volume environment.
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Perform referral processing, obtain necessary documents, and prepare claims for nurse review.
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Apply nurse findings to claims, prepare payment calculations, and generate provider and customer reports.
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Investigate and resolve discrepancies in claims, verify pricing, and confirm prior authorizations.
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Meet productivity, quality, and schedule adherence standards.
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Analyze claims data and identify trends, providing reports as needed.
Required Qualifications
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High School Diploma/GED or equivalent experience.
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Must be at least 18 years old.
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1+ year of experience processing insurance claims or working in billing/collections (healthcare or commercial).
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1+ year of related office/administrative/customer service experience using phones and computers.
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Proficiency with Microsoft Word, Excel, and Outlook.
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Comfortable navigating multiple computer systems.
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Ability to work Monday–Friday, 8:00 AM – 5:00 PM MST.
Preferred Qualifications
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Familiarity with UB04 claim forms.
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1+ year experience processing medical, dental, prescription, or mental health claims.
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Knowledge of HIPAA confidentiality and privacy standards.
Telecommuting Requirements
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Secure, dedicated work area with information privacy.
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Ability to maintain confidentiality of sensitive documents.
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Access to UHG-approved high-speed internet.
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Compliance with UnitedHealth Group’s Telecommuter Policy.
Benefits
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Comprehensive health benefits package.
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Incentive and recognition programs.
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401(k) contribution and stock purchase plan.
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Equity, paid time off, and career development opportunities.
Why Join Optum?
Optum, part of UnitedHealth Group, is a global leader in healthcare innovation. Our mission is to improve health outcomes by connecting people with the care and resources they need. We value diversity, equity, inclusion, and are committed to removing barriers to good health while building a culture guided by compassion and impact.