Provider Claims Resolution Specialist
UnitedHealth Group - Oldsmar, FL

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The Provider Claim Resolution Specialist (PCRS) is responsible for
efficiently navigating claim processing systems to complete all closed and
denied, simple adjustments, and the majority of complex adjustments (out of
scope high dollar and inpatient). Also,
the PCRS will provide quality service to our Providers through real time and
accurate resolution of closed and denied claims, simple adjustments and
escalated claim issues.

Responsibilities:
Perform all types of complex adjustments and
closed, denied, and simple adjustments

Meet Quality,
Productivity and Attendance requirements

Ensure Provider Satisfaction through:
Maintaining accurate documentation in ORS
Providing assistance to Providers with status
updates
Being responsible for any follow-up work needed
for resolving and closing issues
Identifying and resolving anticipated Provider
issues to prevent future calls
Maintain proficiency in all technical
applications (technical skills and system knowledge)
Comply with all current policies, procedures and
workflows

Requirements

Qualifications:
2 years of Claims, Office, or Customer Service
experience analyzing and solving customer problems
Knowledge of medical claims billing ICD9, CPT, or
HCPC codes
High School Diploma, GED or 10 years of work
experience
Authorization to work in the United States
Familiarity with
computer and Windows PC applications, which includes the ability to learn
new and complex computer system applications
Ability to remain
focused and productive each day though tasks may be repetitive
Effective
communication skills

Work Environment:
Extended periods of sitting at a computer and use
of hands/fingers across keyboard or mouse
Office environment

UnitedHealth Group is working to create the health care system of tomorrow.

Already Fortune 25, we are
totally focused on innovation and change.
We work a little harder. We aim a little higher. We expect more from
ourselves and each other. And at the end of the day, we’re doing a lot of good.

Through
our family of businesses and a lot of inspired individuals, we’re building a
high-performance health care system that works better for more people in more
ways than ever. Now we’re looking to reinforce our team with people who are
decisive, brilliant – and built for speed.

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

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a
drug test before beginning employment. In addition, employees in certain
positions are subject to random drug testing.

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