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Job Details

UnitedHealth Group

Non-Clinical Investigator - National Remote (16401139)




Full Time


Dallas, Texas, United States

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Combine two of the fastest - growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making Healthcare data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life’s best work.SM

The Non-Clinical Investigator will be responsible for receiving and reviewing cases to determine if medical records need to be requested for further review. This position supports identification of suspected waste & abuse of health insurance claims. This position is a full time telecommuter position.

This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00am – 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

  • Triaging of medical records (e.g. misroutes)
  • Determine claims that require medical records for review
  • Create medical records request letters
  • Receive and document medical records within case tracking system
  • Perform outreach to providers to obtain documentation to upload within case tracking system
  • Work cases that do not require medical records for review (e.g. hold claims, adjusted claims, etc.)
  • Prepare cases to move to clinical teams
  • Ensure adherence to federal compliance policies, contract compliance
  • Collaboration with clinical investigator, legal and compliance for case review
  • Ability to adapt in a dynamic and high-growth environment
  • Ability to work independently

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 (or higher)
  • 1+ years of health insurance claims experience
  • 1+ years of experience in MS Word and Excel - creating / saving documents and spreadsheets, formulas, pivot tables
  • 1+ years of experience working in a production environment with metrics and QA standards
  • Must be available from 8 - 4:30 PM Central Time for the 1st 6 weeks, Monday through Friday. Regular work schedule will be determined after the initial 6 weeks; adhering to regular business hours.

Preferred Qualifications:

  • Experience working in a Hospital, Physician's office, or Medical Clinic environment
  • Knowledge of Medicaid / Medicare Reimbursement methodologies
  • Experience working with medical claims platforms
  • Experience with Claims Payment Accuracy
  • Experience with Recovery of Claims Payments
  • Experience with Develop / Manage / Maintain Internal and External Relationships

Telecommuting Requirements:

  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
  • Ability to keep all company sensitive documents secure (if applicable)
  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Physical Requirements and Work Environment:

  • Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods working at a computer

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at [Register to View]

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. [Register to View]

Careers with OptumInsight. Information and technology have amazing power to transform the Healthcare industry and improve people's lives. This is where it's happening. This is where you'll help solve the problems that have never been solved. We're freeing information so it can be used safely and securely wherever it's needed. We're creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place to do your life’s best work.SM

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $18.17 - $32.26. The salary range for Connecticut / Nevada residents is $20.00 - $35.53. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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

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.

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