Current jobs related to Senior Claims Examiner - San Antonio - UnitedHealth Group
-
Senior Claims Examiner
19 hours ago
San Antonio, Texas, United States Optum Full timeJob Title: Senior Claims ExaminerWe are seeking a highly skilled Senior Claims Examiner to join our team at Optum. As a Senior Claims Examiner, you will play a critical role in reviewing, analyzing, and researching complex healthcare claims to ensure accuracy and timely processing.Key Responsibilities:Review and process medical claims based on standard...
-
Senior Claims Examiner
4 weeks ago
San Antonio, United States VbkNg8OOEMfz4g Full timeOptum 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,...
-
Senior Claims Examiner
4 weeks ago
San Antonio, Texas, United States University Health Full timeClaims Examiner RoleAs a Claims Examiner at University Health, you will play a critical role in ensuring the accuracy and efficiency of our claims processing system.Key Responsibilities:Conduct thorough reviews and analyses of various claim types, including coordination of benefits and DME claims.Analyze provider appeals and document outcome determinations...
-
Claims Examiner
4 weeks ago
San Antonio, United States University Health System Full timePerforms adjudication of medical (HCFA) or hospital (UB 92) claims for Medicaid, Commercial, and CHIP (Children s Health Insurance Program) according to departmental and regulatory requirements. Maintains audit standards as defined by the Department. Claims, Examiner, Healthcare
-
(Agile) Claims Examiner
4 weeks ago
San Antonio, United States Sedgwick Claims Management Services Full timeTo analyze high-level commercial general liability / bodily injury claims on behalf of our valued clients to determine benefits due, while ensuring ongoing adjudication of claims within service expectations, industry best practices, and specific clie General Liability, Claims, Examiner, Liability, Insurance
-
Claims Examiner
1 month ago
San Antonio, United States GuideWell Full timeJob DescriptionGet To Know Us! WebTPA, a GuideWell Company, is a healthcare third-party administrator with over 30+ years of experience building unique benefit solutions and managing customized health plans. Key position details: This is a fully in office position: 19100 Ridgewood Pkwy San Antonio, TX 78259 Training schedule: 8:00am - 4:30pm Monday -...
-
Claims Examiner II
4 weeks ago
San Antonio, Texas, United States 052 SLIC Insurance Agency, LLC Full timeAt 052 SLIC Insurance Agency, LLC, we are seeking a skilled Claims Examiner II to join our team. As a Claims Examiner II, you will play a critical role in assessing and reviewing incoming claims for payment or denial, serving as a liaison between the carrier and the financial institution.This role provides the opportunity to make a meaningful impact on...
-
Senior Claims Examiner
4 weeks ago
San Antonio, United States University Health Full timePOSITION SUMMARY/RESPONSIBILITIES Performs review, analysis, and adjudication of all claim types including coordination of benefits and DME claims. Performs analysis of provider appeals and documents outcome determination via correspondence. Acts as a provider liaison for claim issue resolution by utilization of appropriate corporate functionalities. ...
-
Claims Examiner
4 weeks ago
San Antonio, Texas, United States University Health System Full timeJob SummaryUniversity Health System is seeking a highly detail-oriented and analytical Claims Examiner to play a critical role in ensuring the accuracy and fairness of medical and hospital claims for Medicaid, Commercial, and CHIP programs.Key ResponsibilitiesAdjudicate medical (HCFA) and hospital (UB 92) claims in accordance with departmental and regulatory...
-
Injury Claims Examiner
24 hours ago
San Antonio, Texas, United States USAA Full timeAbout USAAUSAA is a mission-driven organization dedicated to serving the financial security needs of U.S. military members and their families. Our core values of honesty, integrity, loyalty, and service guide everything we do, from how we treat our members to how we treat each other.The OpportunityWe are seeking a skilled Injury Examiner to join our team. As...
-
Claims Examiner II
2 weeks ago
San Antonio, Texas, United States 052 SLIC Insurance Agency, LLC Full timeJob Summary052 SLIC Insurance Agency, LLC is seeking a skilled Claims Examiner II to join our team. As a Claims Examiner II, you will be responsible for reviewing and evaluating incoming claims for payment or denial, and acting as a liaison for the carrier and the financial institution.Key ResponsibilitiesClaims Adjudication: Adjudicate routine to moderately...
-
Senior Claims Examination Specialist
4 weeks ago
San Diego, California, United States ICW Group Insurance Companies Full timeJob Category : Workers' Compensation ClaimsRequisition Number : CLAIM007236Employment Type: Full-TimeSalary Range: $65,220.24 USD to $109,989.53 USDLocation: Remote/Hybrid options available for qualified candidates.The Senior Claims Examination Specialist is responsible for managing a diverse portfolio of claims, ensuring exceptional service delivery to...
-
Senior Claims Examination Specialist
4 weeks ago
San Diego, California, United States ICW Group Insurance Companies Full timeJob Category : Workers' Compensation ClaimsRequisition Number : CLAIM007236Employment Type: Full-TimeSalary Range: $65,220.24 USD to $109,989.53 USDLocation: Remote options available for qualified candidates.The Senior Claims Examination Specialist is responsible for managing a portfolio of moderate to complex claims, ensuring exceptional service delivery to...
-
Claims Examiner
3 weeks ago
San Antonio, Texas, United States SWBC Real Estate, LLC Full timeJob SummarySWBC Real Estate, LLC is seeking a skilled Claims Adjuster to investigate, evaluate, and negotiate auto claims, CPI and GAP, to determine the extent of liability by interpreting and calculating settlement. Responsible for issuing settlement payments to the Named Insured.Key ResponsibilitiesGathers and assembles pertinent claim information by...
-
Senior Claims Examination Specialist
3 weeks ago
San Diego, California, United States ICW Group Full timeAre you seeking a fulfilling career where your contributions are valued? At ICW Group, we prioritize innovation and adaptability in our workforce. We foster a dynamic work environment that encourages creativity and collaboration to deliver exceptional solutions. Our mission is to provide an unparalleled insurance experience. ICW Group, headquartered in San...
-
Claims Examiner or Senior Claims Examiner
4 months ago
San Jose, United States AssuredPartners Full timeOverview: Administer indemnity claims and handle complex claim issues. Use strong litigation management experience, lien resolution abilities, and customer service skills to resolve routine claims without legal representation. Keenan, an Accretive company, is an insurance brokerage and consulting firm meeting the insurance needs of hospitals, public...
-
Claims Examiner
4 months ago
San Antonio, United States University Health System- San Antonio Full timePOSITION SUMMARY/RESPONSIBILITIES Performs adjudication of medical (HCFA) or hospital (UB92) claims for Medicaid, Commercial, and CHIP (Children's Health Insurance Program) according to departmental and regulatory requirements. Maintains audit standards as defined by the Department. EDUCATION/EXPERIENCE High school diploma or GED equivalent is required....
-
Claims Examiner
3 months ago
San Antonio, United States University Health Full timePOSITION SUMMARY/RESPONSIBILITIES Performs adjudication of medical (HCFA) or hospital (UB92) claims for Medicaid, Commercial, and CHIP (Children’s Health Insurance Program) according to departmental and regulatory requirements. Maintains audit standards as defined by the Department. EDUCATION/EXPERIENCE High school diploma or GED equivalent is required....
-
Senior Claims Analyst
3 weeks ago
San Antonio, Texas, United States Optum Full timeJob OverviewOptum is a worldwide leader in healthcare services, leveraging technology to enhance the well-being of millions. The contributions you make will significantly influence health outcomes by linking individuals with essential care, pharmacy benefits, data, and resources necessary for optimal health. Our culture is rooted in diversity and inclusion,...
-
Claims Examiner I
4 weeks ago
San Leandro, United States Community Health Center Network Inc Full time $23 - $27Job DescriptionJob DescriptionOrganizational DescriptionThe Community Health Center Network (CHCN), sister organization to the Alameda Health Consortium, is made up of the eight federally qualified community health centers in Alameda County. CHCN functions as the managed care MSO for our health centers, contracting with Alameda Alliance for Health. To help...
Senior Claims Examiner
3 months ago
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.
The Senior Claims Examiner is responsible for providing claims support to our teams in reviewing, analyzing, and researching complex health care claims in order to identify discrepancies, verify pricing, confirm prior authorizations, and process them for payment. You'll need to be comfortable navigating across various computer systems to locate critical information. Attention to detail is critical to ensure accuracy which will ensure timely processing of the member's claim.
This position is full time. Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 6am - 6pm CST. It may be necessary, given the business need, to work occasional overtime. Our office is located at 19500 W INTERSTATE, San Antonio TX 78257.
Primary Responsibilities:
- Review, process and identify medical claims based on standard operating procedures on CPS.
- Apply appropriate processes and procedures to process claims (e.g., claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates).
- Review and apply member benefit plans and provider contracts, Pricing, CMS rate letter, SCA's etc. to ensure proper benefits and contract language is applied to each claim.
- Weekly/monthly goal of batches including meeting and maintaining a 95% quality standard and production standard of 90+ claims per day.
- Examine each claim for appropriate coding of CPT and ICD codes against charges that are billed and entered.
- Manually adjust pended escalated claims to resolve complex issues related to claim payments.
- Adjudicate complex medical provider-initiated claims using analytical/problem solving skills.
- Create and generate any overpayment documentation (notes in system, letter to typing) on all overpayments created by the examiner or any overpayments identified by examiner.
- Support implementation of updates to the current procedures and participate in new system updates and training.
- Communicate and collaborate with external stakeholders (e.g., members, family members, providers, vendors) to resolve claims errors/issues, using clear, simple language to ensure understanding.
- Ensures all claims reporting requirements are met; complete daily production reports and weekly pending reports.
Required Qualifications:
- High School Diploma / GED
- Must be 18 years old or older
- 1+ years of experience processing medical, dental, prescription or mental health claims
- 1+ years of experience working in a fast-paced, high volume environment processing 50+ claims per day
- 2+ years of experience in metric-based environment (production, quality)
- Proficiency with Microsoft Office Outlook
- Proficiency with Microsoft Office Word
- Proficiency with Microsoft Office Excel
- Ability to navigate and learn new and complex computer system applications
- Reside within commutable distance to 19500 W INTERSTATE, San Antonio TX 78257
- Ability to work full time. Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 6am - 6pm CST. It may be necessary, given the business need, to work occasional overtime.
- 2+ years of experience working in a fast-paced, high volume environment processing 50+ claims per day
- Proven exceptional ability to organize, prioritize and communicate effectively
California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington or Rhode Island Residents Only: The hourly range for this is $19.47 - $38.08 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
Diversity creates a healthier atmosphere: 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.
#RPO #RED