The Claims Specialist's responsibilities include requesting, reviewing, documenting, and exporting detailed Excel reports related to COB claims in an attempt to provide data related to competitor reimbursement practices to Claim Analysts.Primary Responsibilities:Retrieve claim data via multiple document retrieval systems (iDRS, EDSS)Understand and interpret explanations of benefits (EOB) data from a variety of carriers in a variety of formatsAccurately interpret and document, in an Access database, prime carrier, billed amounts, allowed amounts, primary payer discounts, alternate payments, etc. from EOB's, and/or PRA'sIdentify, document and articulate to internal customers (Claims Analysts) trends and recurring issues related to competitor reimbursement and repriced claim dataRetrieve and interpret claim reports to assist with efficient and accurate documentation and repricing of claims for delivery to internal and external customersAccurately complete Self Check QA through an Access Database by sorting, filtering, etc.Other duties as deemed appropriate to provide a quality, timely product for delivery to our customer
Required Qualifications:Background in claims adjudication and medical coding or billingProven analytical and problem-solving skillsPossess high level of communication skill (written and verbal)Able to work independently with minimal directionAble to manage multiple tasks and projects in a fast-paced environment to meet deadlinesPC proficiencyProven ability to contribute to Team objectives and initiative to follow tasks through to completionDesire to excel and exceed customer expectationsCareers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)Job Keywords: Claims Specialist, Claims, Medical Coding, Coding, Coder, Billing, Claims Adjudication, Gurgaon, Haryana, Hyderabad, Telangana, Noida, Uttar Pradesh
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.