11 days old

Healthplan Analyst (Claims) - Ontario, CA

Ontario, CA 91764
  • Job Code
Let's talk about diplomacy. Let's talk about accuracy. Let's talk about how United Health Group became a Fortune 6 leader in healthcare. We did it by working to become an undisputed leader in creating service quality and helping to improve the lives of millions. Now, here's where you come in. You can build on your problem solving skills by taking on responsibility for reviewing, researching, investigating and triaging claims that were denied to determine their correct status. You'll drive the action and communicate with appropriate parties regarding appeals and grievance issues. In turn, we'll provide you with great training, support and opportunities.

Works as a liaison between the Claims Department and the Health Plan to ensure all related issues are researched and responded to in a timely and efficient manner.

Primary Responsibilities:
  • Responsible for researching and responding to all health plans claim issues received on the contractual arrangements of providers and the health plans in a timely manner
  • Adjust claims as appropriate including calculation of interest and penalties due when applicable
  • Reviews, researches and forwards new claims to the Claims Department for processing
  • Maintain that health plan claims are processed in a timely manner
  • Works with internal departments and health plans to gather information needed to ensure appropriate resolution
  • Identify and forwards non-compliant providers to the Market Executive Director and / or staff, relating the referral of members to non-contracted providers without proper authorization
  • Log and track those issues received from the health plans as identified by Supervisor
  • Identify and report potential issues identified, to the attention of management, which may have an impact on the department's ability to follow established guidelines / policies
  • Contacting providers to reiterate the stipulations of their contracts relating to incorrect billings to members (i.e., copays, balance billings, etc. )
  • Identify, advise, and follow - up with configuration team regarding contract changes and system adjudication problems
  • Foster interpersonal relationships, showing empathy and understanding towards staff, protecting individual self-esteem. Understand own impact on others; interact effectively with peers, subordinates, and supervisors
  • Plan and organize workload to ensure efficient and timely resolution of issues
  • Any other assigned duties and delegated by the Management
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. 



Posted: 2020-06-24 Expires: 2020-07-24

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

Before you go...

Our free job seeker tools include alerts for new jobs, saving your favorites, optimized job matching, and more! Just enter your email below.

Share this job:

Healthplan Analyst (Claims) - Ontario, CA

UnitedHealth Group
Ontario, CA 91764

Join us to start saving your Favorite Jobs!

Sign In Create Account
Powered ByCareerCast