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UnitedHealth Group Claims Representative Associate in Bangalore, India

Roles & Responsibilities :-

-Research, identify and obtain data/information needed to help process claims or resolve claims issues (e.g., verify pricing, prior authorizations, applicable benefits)

-Ensure that proper benefits are applied to every claim

-Apply knowledge of customer service requirements to process claims appropriately (e.g., Service Level Agreements, performance guarantees)

-Identify and apply knowledge of new plans/customers to process their claims appropriately

-Identify and resolve claims processing errors/issues and trends, as needed (e.g., related to system configuration, network, eligibility, data accuracy, vendor-related, provider)

-Resolve or address new or unusual claims errors/issues as they arise, applying appropriate knowledge or prior experience

-Communicate and collaborate with external stakeholders (e.g., members, family members, providers, vendors) to resolve claims errors/issues, using clear, simple language to ensure understanding

-Collaborate with internal business partners to resolve claims errors/issues (e.g., Subject Matter Experts, Network Management, IT/systems staff, Compliance, vendor management teams, contract teams)

-Document and communicate status of claims/investigations to stakeholders as needed, adhering to reporting requirements (e.g., status letters/reports)

-Achieve applicable performance metrics (e.g., productivity, quality, TAT)

Required Qualifications :-

- High school education or equivalent experience.

An education level of at least a high school diploma or GED OR equivalent years of work experience

Proficiency with Windows PC applications, which includes the ability to navigate multiple programs and learn new and complex computer system applications

Preferred Qualification

1+ year of experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools

1+ year experience processing medical, dental, prescription or mental health claims

Making claims a positive experience for our members can drive your sense of impact and purpose. Join us as we improve the lives of millions. Learn more about how you can start doing your life's best work.

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