Senior Claims Representative - Las Vegas, NV

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM

Clinical

Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

Flexible? Friendly? Fast on your feet? That's a great start. Accurate? Accountable? Self Directed? These traits can take you places. Our claims operations are the focal point of handling information about services patients receive and the way those services get paid. It's complex, detailed work. It's fast paced challenge. It's a job that calls on you to be thoughtful, resourceful, team-driven and customer-focused. To put it mildly, there is never a dull moment.

Summary:

The Workers Compensation Examiner I reviews, analyzes, investigates, makes liability decisions and approves the release of benefit payments up to authorized levels on initial, continued and reopened claims.

This position is full-time (40 hours/week) 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. Our office is located at 2720 N Tenaya Way, Las Vegas, Nevada 89128 .

Primary Responsibilities:
  • Evaluates new and on-going claims to determine liability, giving consideration to contract provisions, disability management duration contract guidelines, medical evidence and vocational evidence.
  • Investigates questionable claims. Determines need for additional medical information.
  • Performs periodic follow-ups to verify continued existence of a disabling condition.
  • Responds to telephone and written inquiries from claimants, attorneys, physicians and policyholders.
  • Identifies and forwards claims to specialized internal and external resources in areas such as rehabilitation, investigations, medical exams, settlements and Social Security.
  • Keeps track of time frames required of mandated correspondence.
  • This level is responsible for reviewing routine claims for adjudication purposes. Refers more complex claims to higher levels.

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 GED or equivalent years of work experience
  • 10 key typing experience
  • Experience with creating, editing, sending and saving documents, spreadsheets and correspondence in Microsoft Word, Excel, Outlook and Power Point.
  • Basic knowledge of case law and state Worker's Compensation laws, subrogation, reserve setting, and litigation management
  • Candidates must currently have a Nevada-state staff adjuster license OR be able to obtain one within 30 days.
  • 1+ years of in a worker's compensation claims office

Soft Skills:
  • Experience with multi-tasking and understanding multiple products and multiple levels of benefits within each product
  • Excellent oral and written communication skills required
  • Excellent analytical and problem solving skills required

Physical Requirements and Work Environment:
  • Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouse
  • Office environment

Making claims a positive experience for our members can drive your sense of impact and purpose. Join us as we improve the lives of millions. Learn more about how you can start doing your life's best work. SM

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 https://uhg.hr/transitioning-military

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet

Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is 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: claims, worker's comp, Las Vegas, disability claims, case law, determinations, subrogation, customer service, #rpo, hiring immediately

Advertisement

941543