Claims Representative - San Juan, PR Details

Claims Representative - San Juan, PR

UnitedHealth Group - San Juan, PR

Employment Type : Full-Time

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.(sm)


Positions in this function are responsible for providing general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims.


Primary Responsibilities:

  • Authorizes the appropriate payment or refers claims to investigators for further review
  • Conducts data entry and re-work as required
  • Responsible for handling issues within turnaround standards
  • Process rework issues
  • 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:

  • High school diploma or higher
  • 1+ years of experience interpreting procedures and guidelines
  • Previous experience in Healthcare Industry
  • Proficient in MS Office with strong computer skills (e.g. multiple systems experience, keyboarding skills, Microsoft word, Power Point)
  • Proficient in verbal and written English skills
  • You will be asked to perform this role in an office setting or other company location
  • Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained.
Preferred Qualifications:
  • Experience in a production environment
  • Claims Experience

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)



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.


Job Keywords: Claims Representative, Claims Analyst, Representative, San Juan, Puerto Rico, PR

Posted on : 3 years ago
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