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Workers Compensation Claims Examiner III - Las Vegas, NV

Company: UnitedHealth Group
Location: North Las Vegas
Posted on: March 18, 2023

Job Description:

$1,000 Sign On Bonus For External Candidates

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing 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.

This position is full-time (40 hours/week) Monday to Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 08:00am - 05:00pm. It may be necessary, given the business need, to work occasional weekends and overtime. Our office is located at 2720 N TENAYA WAY, LAS VEGAS, 89128.

Primary Responsibilities:

  • Evaluates new and on-going claims to determine compensability and liability, giving consideration to contract provisions, disability management duration contract guidelines, medical evidence and vocational evidence.
  • Investigates questionable claims. Determines needs for additional medical information.
  • Determine appropriate benefit calculations and payments. Performs reviews to verify initial and continued existence of a disabling condition.
  • Responds to telephone and written inquiries from claimants, attorneys, physicians and policyholders within statutory requirements.
  • Identifies and forwards claims to specialize internal and external resources in areas such as medical exams, rehabilitation, investigations, subrogation and subsequent injury.
  • Track time frames as mandated by statute and regulation. Respond to correspondence to include litigation compliance with decisions & orders.
  • This level is responsible for independently reviewing simple to complex claims for adjudication purposes. Refers more complex claims to higher levels for review and direction.
  • This level is responsible for administering complex including catastrophic and death claims
    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)
    • 5+ years of experience processing and adjudicating simple to complex claims
    • Experience with catastrophic claims
    • Must have the Nevada Staff Adjuster License
    • Experience Excess Reporting, Subsequent Injury and Subrogation Claims
    • Experience with fundamental concepts, practices and procedures of case law and state Worker's Compensation laws, subrogation, reserve setting, and litigation management
    • Experience with Microsoft Office including Microsoft Word (create correspondence and work within templates), Microsoft Excel (ability to sort, filter, and create simple spreadsheets), and Microsoft Outlook (email and calendar management)
      Soft Skills:
      • Excellent analytical and problem-solving skills
      • Excellent oral and written communication skills
      • Ability to multi-task and understand multiple products and multiple levels of benefits within each product
        Physical Requirements and Work Environment:
        • Office environment
        • Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouse
          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 healthcare. 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

          Nevada Residents Only: The salary range for Nevada residents is $46,700 to $91,300. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

          PLEASE NOTE The sign on bonus is only available to external candidates. Candidates who are currently working for a UnitedHealth Group, UnitedHealthcare or related entity in a full time, part time, or per diem basis ("Internal Candidates") are not eligible to receive a sign on bonus.

          At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe 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 experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

          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: UnitedHealth Group, North Las Vegas , Workers Compensation Claims Examiner III - Las Vegas, NV, Other , North Las Vegas, Nevada

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