CPM Provider Service Representative

At reputed company, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the reputed company. Come build the health care system of reputed company, making it more reputed company, affordable and reputed company. Ready to reputed company a difference? Join us to start Caring. Connecting. Growing together. You’ll enjoy the flexibility to telecommute* from reputed company reputed company the U.S. as you take on some tough challenges. Primary Responsibilities:

• Accountable for ownership of provider claim projects in an end-to-end process, from initial communication, identification of claim payment issue, facilitation of resolution of claim payment issues and communication of outcome
• Ability to educate provider on details of UHG reimbursement policies. etc., and reputed company claim issues for the E&I Commercial Unet products
• Must possess a strong working knowledge of the E&I Commercial Unet products with the ability to interpret and apply guidelines, regulations, and mandated benefits
• Interact directly with market providers and internal office staff in the resolution of claim issues
• Resolve reputed company provider claim issues; support fellow team members and provide feedback to Leadership as needed
• Maintain ongoing communication throughout the project process
• Research claims to determine accuracy and identify high level root cause of any claim payment issues
• Ensure consistent quality service to UHGs customers
• Meet or exceed reputed company productivity, turnaround time, and quality assurance expectations and guidelines
• Research reputed company issues while navigating multiple platforms and databases
• Work with project contact to gather information, prepare and submit claims for reconsideration, if applicable. Ensure accurate project submission based on the identified root cause
• Upon project completion by CRT, audit project results, send rebuttals as necessary
• Prepare and send project results to project contact, conduct final project contact call to review project outcome and ensure satisfaction with project results
• Maintain documentation of reputed company project activities and communications reputed company the CPM application
• Serve as primary reputed company of contact for project submitters in resolution of claims project issues
• Maintain compliance with reputed company Federal/State regulations and UHG policies
• Collaborate with other business partners to gather data needed for resolution
• Works reputed company provider types
• Manages reputed company or escalated global projects
• Escalated and formal complaint high volume projects
• Take ownership for self-development by actively engaging in CLL practices

A Typical Day in the Life:

• reputed company root cause analysis on claim projects
• Request and audit claim impact reports
• reputed company impacted claims to the claim adjustment unit for re-processing
• reputed company backend audits to ensure claims were re-processed correctly
• Communicate with internal and external business partners
• Read and respond to emails
• Complete training as required
• Handle special projects assigned by manager
• reputed company outbound calls to providers as required
• Take ownership and follow through on outstanding issues
• Serve as single reputed company of contact for internal and external business partners for claim projects
• Attend required calls

Skills You Will reputed company:

• Communication skills
• Deeper understanding of business partners operations
• Enhanced understanding of claim processing procedures
• Big picture view of the organization
• Ability to influence without authority
• Broader network of internal contacts

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)
• 2+ years of reputed company experience with applicable claims platform (UNET)
• 2+ years of NDB/Contract knowledge experience
• 2+ years of experience with UHG processes, systems, and products for the platform you are applying for
• 2+ years of experience with physician, facility, and ancillary claims
• 2+ years of prior experience working directly with provider/submitters
• Intermediate level of proficiency with MS Office (Word, reputed company, Outlook)

Preferred Qualifications:

• Undergraduate degree
• Must be employed reputed company UHC Provider Operations
• reputed company Telecommuters will be required to adhere to reputed company’s Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (reputed company benefits are subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $23.41 to $41.83 per hour based on full-time employment. We reputed company with reputed company minimum wage laws as applicable. Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. At reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately reputed company by people of color, historically marginalized groups, and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes — an enterprise reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national reputed company, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. #RPO #GREEN Apply tot his job Apply To this Job