Current jobs related to Senior Claims Examiner - San Antonio - Optum
-
Senior Claims Examiner
5 days 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
2 days 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
3 days 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
-
Senior Claims Examiner
2 months ago
San Antonio, United States Optum Full timeJob DescriptionWellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans...
-
(Agile) Claims Examiner
1 week 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
2 weeks ago
San Antonio, United States Florida Blue Full timeGet 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 - Friday What is your...
-
Claims Examiner
2 weeks 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 -...
-
Senior Claims Examiner
2 weeks ago
San Antonio, United States UnitedHealth Group Full timeWellMed is part of OptumCare , a division under the greater UnitedHealthcare Group umbrella. We have a network of doctors, specialists and other medical professionals that specialize in providing the highest level of medical care for more than 1 million older adults with over 16,000 doctors’ offices in Texas and Florida. We’re growing, and we are making...
-
Senior Claims Examiner
4 weeks ago
San Antonio, United States Optum Full timeJob DescriptionOptum 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...
-
Claims Examiner II
4 days 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
3 days 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
2 days 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...
-
Claims Examiner
4 weeks ago
San Francisco, United States San Francisco Health Plan Full timeYou can make a difference in the San Francisco community. San Francisco Health Plan is seeking a full-time Claims Examiner. The Claims Examiner is responsible for claims processing, adjudication, and research. In addition, this position keeps current on claim processing procedures, produces a quality and timely work product, and assists Claims Management...
-
Claims Examiner
2 months ago
San Francisco, United States San Francisco Health Plan Full timeYou can make a difference in the San Francisco community. San Francisco Health Plan is seeking a full-time Claims Examiner. The Claims Examiner is responsible for claims processing, adjudication, and research. In addition, this position keeps current on claim processing procedures, produces a quality and timely work product, and assists Claims Management...
-
Claims Examiner
2 months ago
San Francisco, United States San Francisco Health Plan Full timeJob DescriptionJob DescriptionYou can make a difference in the San Francisco community. San Francisco Health Plan is seeking a full-time Claims Examiner.The Claims Examiner is responsible for claims processing, adjudication, and research. In addition, this position keeps current on claim processing procedures, produces a quality and timely work product, and...
-
Claims Examiner
3 months ago
San Francisco, United States San Francisco Health Plan Full timeJob DescriptionJob DescriptionYou can make a difference in the San Francisco community. San Francisco Health Plan is seeking a full-time Claims Examiner. The Claims Examiner is responsible for claims processing, adjudication, and research. In addition, this position keeps current on claim processing procedures, produces a quality and timely work product, and...
-
Claim Examiner
4 weeks ago
San Francisco, United States Collabera Full timeJob DescriptionJob DescriptionIndustry: ITTitle: Claim Examiner/AdjusterLocation: RemoteRates: $19/hr. - $20/hr. without benefitsDuration: 7 months Contract with higher extension possibilities. JOB DESCRIPTIONThis is a Claims Examiner for Travel Insurance ClaimsMust-Have Active New York Adjusters LicenseResponsibilities:• Investigate, evaluate, and settle...
-
Senior Claims Examination Specialist
7 days 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
7 days 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...
-
Senior Claims Examination Specialist
2 days 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...
Senior Claims Examiner
2 months ago
Job Description
WellMed is part of OptumCare, a division under the greater UnitedHealthcare Group umbrella. We have a network of doctors, specialists and other medical professionals that specialize in providing the highest level of medical care for more than 1 million older adults with over 16,000 doctors’ offices in Texas and Florida. We’re growing, and we are making a difference by helping our patients achieve better health. With opportunities for physicians, clinical staff and non - patient - facing roles, you can make a difference with us as you discover the meaning behind Caring. Connecting. Growing together.
Making sure you fit the guidelines as an applicant for this role is essential, please read the below carefully.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 work our normal business hours of 6:00 AM - 6:00 PM 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.
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:
- High School Diploma / GED
- Must be 18 years of age OR older
- 2+ years of experience in a metric - based environment (production, quality)
- 1+ years of experience with working in a fast - paced, high - volume environment and processing 50+ claims per day
- 1+ years of experience with processing medical, dental, prescription, OR mental health claims
- Proficiency with Microsoft Office Suite (Microsoft Word, Microsoft Excel, Microsoft Outlook, etc.)
- Ability to navigate and learn new and complex computer system applications
- Reside within a commutable distance of 19500 W Interstate, San Antonio, TX, 78257
- Ability to work any of our full - time, 8-hour shift schedules during our normal business hours of 6:00 AM - 6:00 PM CST from Monday - Friday. It may be necessary, given the business need, to work occasional overtime.
Preferred Qualifications:
- 2+ years of experience with working in a fast - paced, high - volume environment and processing 50+ claims per day
Soft Skills:
- Proven exceptional ability to organize, prioritize, and communicate effectively
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.
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 #RPOLinkedIn
