Claims Representative - Las Vegas, NV

Position Description:

* Adjudication of claims to achieve quality and production standards applicable to this position

* Analyze medical claims to ensure accurate claims adjudication. Claims processing in accordance with EOC, Benefit Schedules and Provider Contracts

* Release by deadline to meet Company, state regulations, contractual agreements and group performance standards

* Problem identification and reporting to management

* Resolution of high profile and complex projects

* Performs all job functions with a high degree of discretion and confidentiality in compliance with federal, SHS and departmental confidentiality guidelines

OptumHealth is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.

If you want more meaning in your career - as a clinician or a business professional - think of OptumHealth as your calling.

By providing 58 million Americans with information, tools and solutions, we are helping to guide them through the health care system, financing their health care needs, and enabling them to achieve their personal health and well-being goals.

At OptumHealth, you will perform within an innovative culture that's focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact that's greater than you've ever imagined.

• High school education or equivalent experience
• 2 plus years of medical claims processing experience in HMO, PPO or indemnity products
• Must demonstrate knowledge of or ability to learn and apply to job functions, those state and federal laws and regulations applicable to the operating unit
• Medical terminology, ICD-9, CPT4, HCPCS, ASA, RBRVS, PDR, Insurance Certificates, Benefit Schedules, Provider/Group Contracts, and Standard Insurance Industry Practices is required
• Must have thorough knowledge of Insurance State and Federal laws and regulations
• Understanding of basic math
• Experience with Facets platform a plus
• Advance computer skills and 10-key by touch
• Ability to work under pressure in high production environment
• Ability to maintain balanced performance in areas of production and quality
• Analytical reasoning and flexibility
• Positive work ethic
• Strong team player skills
• Ability to make difficult decisions
• Basic writing skills