Claims Representative - San Juan, PR
Optum, San Juan, San Juan, United States
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.
Primary Responsibilities
Authorizes the appropriate payment or refers claims to investigators for further review
Conducts data entry and claims processing/issues
Handling issues within turnaround standards
Ability to handle most claim types / cases / issues that are submitted to the team you are supporting
Ability handle escalations as needed
Ability to work multiple functions and applications in a day as needed
Communicate any changes in trending of inventory, volumes, and quality remediation
Complete required individual development courses / training
Meet and maintain minimum quality and productivity standards
ENGLISH PROFICIENT 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
1+ years of experience in a production environment
Proficient in MS Office with solid computer skills (e.g. multiple systems experience, keyboarding skills, Microsoft word, Power Point)
Proficient in verbal and written English skills
Willing or able to work 40 hours / week during standard business operating hours Monday - Friday from 7am - 7pm AST (It may be necessary, given the business need, to work occasional overtime on weekends and holidays)
Preferred Qualifications
Experience in medical billing or claims
Healthcare experience
UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.
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Caring. Connecting. Growing together.
Primary Responsibilities
Authorizes the appropriate payment or refers claims to investigators for further review
Conducts data entry and claims processing/issues
Handling issues within turnaround standards
Ability to handle most claim types / cases / issues that are submitted to the team you are supporting
Ability handle escalations as needed
Ability to work multiple functions and applications in a day as needed
Communicate any changes in trending of inventory, volumes, and quality remediation
Complete required individual development courses / training
Meet and maintain minimum quality and productivity standards
ENGLISH PROFICIENT 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
1+ years of experience in a production environment
Proficient in MS Office with solid computer skills (e.g. multiple systems experience, keyboarding skills, Microsoft word, Power Point)
Proficient in verbal and written English skills
Willing or able to work 40 hours / week during standard business operating hours Monday - Friday from 7am - 7pm AST (It may be necessary, given the business need, to work occasional overtime on weekends and holidays)
Preferred Qualifications
Experience in medical billing or claims
Healthcare experience
UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.
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