Accurate processing and completion of medical claims
Process claims that route out of automatic adjudication, within current turnaround standards
Proficiency in product lines applicable to processing unit
Understand and apply plan concepts to include: Deductible, Coinsurance, Co-pay, State variations
Recognize issues related to variable deductible, coordination of benefits, carve-out and alternate benefits
Recognize potential pre-existing conditions, misstatements and fraudulent claims
Process correspondence and requests for reconsideration within time service standards
Use pre-approved electronic letters as well as handwritten letters to communicate with customers, providers, attorneys, regulators and other external entities
Adhere to quality improvement initiatives
Demonstrate increasing productivity to meet minimum requirements while maintaining quality standards
Special projects as required
Required Qualifications:
College Graduate
2-3 years of customer service experience analyzing and solving customer problems
Minimum 1 year of experience in Medical Billing (Payment posting/AR Calling/Charge Entry/Denial management/Cash posting)
Experience working in the healthcare industry
Experience working with claims and/or recovery
Proficiency with computer and Windows PC applications
The Optum Ireland, part of the UnitedHealth Group family of businesses, Automation Centre of Excellence is an exciting new venture that’s passionate about process automation. We support the organization through the delivery of automation solutions, using existing, new and emerging technologies to enhance savings, improve productivity and quality and reduce cost.
