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.
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
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
Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouse
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, weâ€™re doing a lot of good.
Through our family of businesses and a lot of inspired individuals, weâ€™re building a high-performance health care system that works better for more people in more ways than ever. Now weâ€™re looking to reinforce our team with people who are decisive, brilliant â€“ 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.
UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier...