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LHI - Claims Resolution Specialist I - La Crosse, WI

Company: UnitedHealth Group
Location: La Crosse
Posted on: March 22, 2020

Job Description:

At Optum , the mission is clear:  Help people live healthier lives and help make the health system work better for everyone LHI is one of 4 businesses under OptumServe . OptumServe  provides health care services and proven expertise to help federal government agencies modernize the U.S. health system and improve the health and well - being of Americans. By joining OptumServe you are part of the family of companies that make UnitedHealth Group a leader across most major segments in the U.S. health care system. LHI was founded in 1999 and acquired by Optum in 2011, LHI specializes in creating and managing health care programs through on - location services, patient - specific in - clinic appointments, tele - health assessments, or any combination based on customer need. LHI 's customizable solutions serve the diverse needs of commercial customers, as well as federal and state agencies, including the U.S. Departments of Defense, Veterans Affairs, and Health and Human Services. There's an energy and excitement here, a shared mission to improve the lives of others as well as our own. Ready for a new path? Start doing  your life's best work. SM     The LHI - Claims Resolution Specialist I will process dental claims and coordinate claims inquiries for certified Veterans of the VA Community Care Network program throughout the United States. Data entry of dental claims data.  Educate and inform Providers of program coverage and limitations for claims within contract requirements.  Respond to cases involving Veteran’s claims with Customer Service staff.  Use critical thinking, research and problem - solving skills to navigate through the complexities of a Veteran’s episode of care requirements and their respective dental claims while maintaining coverage within the program guidelines Primary Responsibilities: Maintain an ongoing responsibility for assigned claims inquiries which entails assessment, education and coordination for members / health care providers throughout the United States via telephone while keeping a detailed record within the internal database. Establish and maintain positive relationships with members, providers and our claims contractors Manage inbound and outbound calls from providers and members to resolve claims issues Request and manage medical records to help determine potential program coverage and communicate results to the members Completion of system generated tasks, including documenting all results as required Prepare comprehensive reviews and summaries for claims appeals Point of contact for internal departments to answer questions relative to member claims Work with the leadership team to resolve issues as needed Able to handle emotionally charged phone calls and ability to deliver unfavorable claims outcomes Ability to communicate complex program criteria into easily understood summaries in both oral and written communication Validation of claim coverage in relation to program guidelines Compete activities and reporting as required by the fraud, waste and abuse plan 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) Working knowledge of health insurance claims OR patient financial services OR Revenue Cycle experience (similar experience may be considered) Experience providing customer service over the phone Ability to work an 8 hour shift between the hours 7:30 am- 5:00 pm, Monday - Friday Preferred Qualifications: Customer service experience within a call center Experience and knowledge of medical claims, Medicare / Medicaid guidelines Working knowledge of Medical Terminology Proficient in Microsoft Office Suite including Microsoft Word (create, edit, save), Microsoft Excel (create, edit, save), and Microsoft Outlook (send and receive emails) Soft Skills: Able to handle emotionally charged phone calls and ability to deliver unfavorable claims outcome Ability to communicate effectively both verbally and in writing Strong organization, planning, interpersonal and multi - tasking skills Must be a self - starter and comfortable with confidential information Attention to detail, strong problem - solving and time - management skills Ability to work in a fast - paced environment, flexible and adaptable to changing situations, and a strong commitment to teamwork Proven skills to establish rapport, trust and confidence with internal departments, staff and external vendors Ability to remain calm in stressful situations and to conduct themselves in a professional manner at all times Must be able to identify and define problems; collect data; establish facts and draw valid conclusions Careers with LHI. Our focus is simple. We’re innovators in cost - effective health care management. And when you join our team, you’ll be a partner in impacting the lives of our customers, and employees. We’ve joined OptumHealth, part of the UnitedHealth Group family of companies, and our mission is to help the health system work better for everyone. We’re located on the banks of the beautiful Mississippi River in La Crosse, Wis., with a satellite office in Chicago and remote employees throughout the United States. We’re supported by a national network of more than 25,000 medical and dental providers. Simply put, together we work toward a healthier tomorrow for everyone. Our team members are selected for their dedication and mission - driven focus. For you, that means one incredible team 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.   Keywords: medical claims, health insurance claims, patient financial services, revenue cycle, claims processing, customer service, CPT, Medicare, Medicaid, La Crosse, WI

Keywords: UnitedHealth Group, La Crosse , LHI - Claims Resolution Specialist I - La Crosse, WI, Other , La Crosse, Wisconsin

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