Claims Processor - Intermediate

Adecco is currently assisting a local client in their search to fill Claims Processor – Intermediate in Minnetonka, MN! Apply now if you meet the qualifications listed below!

Description:
High Level Overview of the Role
The Resolution Representative supports the prospective, Waste and Error review of medical records by retrieving appropriate medical records from source systems. This role will also ensure the appropriate navigation of medical records upon receipt from the providers. The Recovery/Resolution Representative must utilize the claims platform, and multiple applications to determine if the medical record matches a claim that was stopped for an Optum, post-payment review. They must have working knowledge of all the United Health Group claims platforms (COSMOS, Unet, Facets…), medical record layout, United Health Group mail repository applications, and multiple internal applications to aid in their decision making. After the claim/case has been identified to be an Optum suspected claim, the Representative, must determine the medical records appropriate pathway, assign the appropriate clinical review drop dead date based upon the state and government required turnaround times, and adhere to strict process turnaround times in order to avoid adversely impacting the overall savings of the department. The Representative must also possess critical thinking skills to easily recognize which team the medical record belongs to. This team impacts multiple teams based on the nature of the United Health group mail assignment processes, and is vital to ensuring the Waste and Error teams meet their internal and external SLAs and savings targets.
Must have qualifications/experience:
Required Qualifications:
• High school diploma or GED
• 1+ year experience within an office environment
• 1+ year experience with MS Office: Word and Excel
• 1+ years’ experience working in a production and quality based metric environment.
• Strong typing and keying (data entry) skills
• Strong written and verbal communication skills
• A strong ability to monitor details for accuracy and personal organization to work unattended and with little managerial oversight.

Candidates should have Claims processing experience to be submitted for consideration.

Preferred Qualifications:
• Health insurance knowledge, managed care experience
• Understanding of state/government regulatory and compliance guidelines

• Medical record familiarity

Shift Start/End Time: Days - business hours

Dress Code: business casual

** FT Job description is attached, take a look if you'd like some additional insight.
Dress Code: Casual IMPORTANT: This position is being recruited for by Adecco’s National Recruitment Center, not your local Adecco Branch Office. To be considered for this position, you must use the “apply now” button to submit your resume. If you have questions about the position, you may contact the recruiter recruiting for this position listed above. For other opportunities available at Adecco go to www.adeccousa.com.


If you have any questions surrounding the application process, please feel free to reach out to Yulia Le Good, Yulia.legood@adeccona.com, tel. 631-844-2804

The Adecco Group is a global leader in HR services. Our group connects over 700,000 associates with our business clients each day through our 6,600 offices in over 70 countries and territories around the world. We offer employment opportunities at any stage in your professional career. Contact us today to discuss available contract and direct hire positions. Adecco Group provides one of the most comprehensive benefits packages in the industry to contract workers to include Holiday, 401(k) and Insurance Benefit Plans.
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Reference number US_EN_2_022862_408393