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 600,000 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
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 200 Workplace for 14 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.
CLAIMS ANALYST SENIOR - ISSUE MANAGEMENT
Work Location: Work from Home
This position is responsible to research, resolve, examine and process complex provider or member claim issues using current Claim's processing technology. Develop detailed documentation of issues and resolution. Serve as a mentor for others in the team or department. Consistently exhibit a high level of customer service and adherence to department audit guidelines.
• Responsible for independent review and timely/accurate review and resolution of complex claims issues in accordance with DHS and CMS Regulations and Claims Department Work Instructions, Job Aids or direction from department leadership.
• Review and disposition claims issues for all UCare products while maintaining.
• Research claim issues and identify root cause to avoid future claim issues.
• Respond timely to claims inquiries and issues. Inquiries may include phone calls, e-mails, and verbal requests including services agreements and recovery requests.
• Work pending files and provide timely communication as directed by CCO Leadership. Follow up on pending claims and adjustments accordingly to Department Service Level Agreements and regulatory requirements.
• Interact with internal customers to obtain needed information to resolve issues and process impacted claims and to provide detailed claim information for resolution.
• Other projects and duties as assigned.
High school diploma or equivalent, Bachelor's degree; demonstrated experience may be considered in lieu of degree.
Three years of progressively complex specialty claims experience. Industry terminology claims technical knowledge, and background in regulatory local market or for associated line of business. Ability to work both independently and as a member of a team. Must maintain a high level of accuracy and provide follow-through on projects. Excellent communication and documentation skills.
Associate in Claims designation. Associate in General Insurance designation.
Knowledge of Amisys Claims System, HealthRules Payor and MACESS EXP experience.
THE UCARE DIFFERENCE
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: 9/20/2023