Remote Medical Claims Processor Jobs in Puerto Rico

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

As a Collections Representative for Dignity Health, you'll play a critical role in creating a quality experience that impacts the financial well-being of our patients. You'll be the expert problem solver as you work to quickly identify, analyze, and resolve issues in a fast-paced environment.  This is your chance to take your career to the next level as you support teams by reviewing and resolving claims. Bring your listening skills, emotional strength, and attention to detail as you work to ensure every claim has an accurate, fair, and thorough review.

If you are located in San Juan, PR, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Complies with departmental Business Rules and Standard Operating Procedures
• Review and research insurance follow-up, and denied claims by navigating multiple systems simultaneously, such as payer portals, to accurately capture data/information for accurate processing
• Comprehensively understand payer and state specific policies for claim resolution
• Interprets explanation of benefits for appropriate follow up action
• Prioritize aged accounts by discharge date, and collaborate with leadership to determine accounts on which to take action
• Complete outbound calls as needed to payors for claim status
• Focuses efforts on decreasing the accounts receivable, increasing cash, and/or reducing bad debt
• Utilizes payer portals to verify eligibility, claim status and/or to obtain better claim insight information
• Works directly from our main system to review and resolve claims for accurate resolution
• Communicate and collaborate with Patient Access or other back-end departments to ensure clear understanding on claims errors/issues and trends, using clear and simple language
• Identify account issues that need to be escalated to senior leadership or internal partners, for resolution
• Conduct data entry and re-work for adjudication of claims
• Work on multiple simultaneous projects as needed
• Meet the performance goals established for the position in the areas of efficiency, accuracy, quality, client satisfaction and attendance
• This position is full-time (40 hours/week) with our site operating from Monday - Friday from 9:30AM - 6:30PM. It may be necessary, given the business need, to work occasional overtime and/or weekends or holidays
• If selected for this position, it is required that you successfully complete the UnitedHealth Group new hire training and demonstrate proficiency to continue in the role
• Other duties may apply

**ENGLISH PROFICIENCY ASSESSMENT WILL BE REQUIRED AFTER APPLICATION**

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.

Required Qualifications:

• 6 months of experience in collections, billing or healthcare claims
• Experience using computer and Windows PC applications, which includes solid keyboard and navigation skills and ability to learn new computer programs
• Experience with Microsoft Tools: Microsoft Word (creating memos, writing), Microsoft Outlook (setting calendar appointments, email) and Microsoft Excel (creating/editing spreadsheets, filtering, navigating reports)
• Ability to work 40 hours / week during standard business operating hours Monday - Friday from 9:30am - 6:30pm AST. It may be necessary, given the business need, to work overtime or weekends
• Professional proficiency in both English and Spanish (bilingual)

Preferred Qualifications:

• Certified Medical Coder
• Experience in Account receivable, Insurance and/or Healthcare
• Experience processing medical claims
• Experience working in a fast-paced environment
• Medical terminology acumen
• Medicare/Medicaid knowledge

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.