Claims Services Representative - Claims Support

7 days left

Minneapolis, Minnesota
Aug 26, 2021
Sep 28, 2021
Employment Status
Full Time
Health Care that Starts with You!

Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs.

UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.


Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers.

At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.




UCare offers Medicare, Medicaid, Individual and Family health plans - powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.


Working at UCare is more than a career; it's a mission. A mission that defines us as professionals, unites us as an organization and shapes how we interact with our members and each other. Employees join UCare and stay because of the opportunity to have a purpose-driven job.

Our strong culture has established UCare as a Star Tribune Top 150 Workplace for 12 consecutive years since the awards program began. It's a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.


Work Location: In the office 5 days per week.

This position requires employees to be on site. The health and safety of our employees, members, providers, and our community is our highest priority. Therefore, all new employees are expected to be fully vaccinated against COVID-19 prior to starting at UCare, subject to limited exceptions such as for a sincerely held religious belief or for medical reasons.

Position Description

This position is responsible to perform a variety of claims services support functions, including but not limited to, subrogation, claims processing, cost estimates, mail handling, scanning documents, filing claims, and assisting with DTR and other member denial letters. Interact with internal customers to obtain needed information for processing. Process claims in accordance with work instructions and applying appropriate plan provisions, CMS Regulations and DHS guidelines for payment determination.

• Ensure accurate and timely processing of claims in accordance with DHS and CMS Regulations and Claims Department Work Instructions.

• Provide support services such as prepping, counting, scanning and filing mail and claims, operating in Formworks and assigning work to department work queues, assist with member denial letters, Identify and forward subrogation documents to Optum, navigate in HealthRules Payor and Amisys to locate essential information,

• Respond timely to claims inquiries and issues. Inquiries may include phone calls, e-mails, and verbal requests including Subrogation and adjustment requests.

• Deliver documents to internal departments via Macess-EXP.

• Accurate and timely entry of DTR letters into Amisys.

• Doc triage documents that are not compatible with Formworks such as faxes, enrollment applications, and claim adjustments.

• Review and respond to correspondences received in the claim fax mailbox.

• Maintain department production and quality standards.

• Work pending file as directed by Claims Leadership. Follow up on pending claims according to Department Service Level Agreements.

• Interaction with internal customers to obtain needed information to process claims and to provide detailed claim information.

• Other projects and duties as assigned.


High School diploma or equivalent.

Required Experience

Experience with medical claims knowledge. Previous claims processing. Strong data entry skills.

Preferred Experience

Experience in a healthcare organization, working knowledge of Medicaid, Medical Assistance, Minnesota Care, Medicare and Commercial. Amisys Claims System and MACESS EXP experience.


The UCare difference is our people power - employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, helps you build on your strengths and gives you the opportunity to truly make a difference, we invite you to apply.

As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.

JOB POST DATE: 08/25/2021

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