Medical Claims Examiner

7 days ago


Redlands, California, United States Optum Full time

We are seeking a detail-oriented Medical Claims Examiner to join our team at Optum, a global organization that delivers care and technology to help millions of people live healthier lives.

As a Medical Claims Examiner, you will play a critical role in ensuring the accurate processing of medical claims, working closely with insurance carriers and patients to resolve outstanding claims. This is a full-time position with a competitive salary range of $16.54 - $32.55 per hour, based on various factors including local labor markets, education, work experience, and certifications.

Key Responsibilities:
  • Contacting insurance carriers/patients regarding outstanding insurance claims to obtain proper payment
  • Preparing documentation for appeals to insurance carriers
  • Ensuring all accounts are set up correctly in the computer using knowledge of A/R software, understanding of eligibility requirements, and use of the internet
  • Having thorough knowledge of insurance carrier procedures and processes
  • Understanding contract reimbursement rates for individual carriers/networks
  • Processing refunds when applicable
  • Investigating and correcting prepayments
Requirements:
  • High School diploma/GED equivalent
  • Must be 18 years of age or older
  • 1+ years of experience in medical insurance billing
  • Ability to work any of our 8-hour shift schedules during our normal business hours of 7am – 4pm, with occasional overtime as needed
About Optum:

Optum is committed to delivering equitable care that addresses health disparities and improves health outcomes. We strive to create a healthy atmosphere by promoting diversity, equity, and inclusion in all aspects of our business. 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.



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