Job Details

Eligibility Assistant

Optum CA is seeking an Eligibility Assistant to join our team in San Diego, California. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone. At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

As an Eligibility Assistant you will research eligibility issues regarding active dates, termed dates, assigned primary care physicians, and address corrections for members enrolled with one of our groups, and updates the EZCap system accordingly.

Primary Responsibilities:

• Works daily reports from member notes and claim notes to verify, clarify, and update member eligibility. Looks up member on health plan websites and/or calls the plans for verification. Enrolls and updates individual members in EZ-Cap. Responds back via EZ-Cap member notes. All reports must be completed by the end of the day.
• Researches 'not on file' claims, within 1 day of receipt of claim by the production area. If eligibility is verified with one of our groups accurately updates the EZCap system and notifies Production Assistant. If eligibility is located with another group, or no eligibility is located, notifies Production Assistant where to forward the claim, or to return the claim back to the provider for health plan card.
• Researches the EZCap system and health plan eligibility information via their website or telephone for eligibility verifications e-mailed to Eligibility Inquiry.
• Routine requests within 1 business day
• Stat/Urgent requests within 2 hours of the request.
• Updates member address information from member updates and returned mail.
• Assists Eligibility Analysts as needed.
• Prepares a weekly report for the Manager of Claims and Eligibility indicating the total eligibility verifications for Medical Management, Claims, and Client Services. The report is due to the Manager by the end of each week.
• Other duties as assigned

Required Qualifications:

• High School Diploma / GED OR equivalent work experience
• Must be 18+ years of age OR older
• 1+ years of experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools
• Experience with computers and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
• Experience with Microsoft Word (create correspondence and work within templates), Microsoft Excel (data entry, sort / filter, and work within tables) and Microsoft Outlook (email and calendar management), and Access (entering data)
• Ability to work fulltime, (40 hours/week) Monday - Thursday. Employees are required to have flexibility to work a 10-hour shift schedule during our normal business hours of (5:45am -4:15pm) PST. It may be necessary, given the business need, to work occasional overtime. Candidates must be flexible to come on-site per business need.

Preferred Qualifications:

• Managed care eligibility experience.
• Eligibility/enrollment experience

Telecommuting Requirements:

• Reside within commutable distance to the office at 6760 Top Gun Street, Suit 201 San Diego, CA
• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

*All employees working remotely will be required to adhere to UnitedHealth Group'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 (all benefits are subject to eligibility requirements). The hourly pay for this role will range from $16.15 - $28.80 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. 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.

OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, 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.

OptumCare is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.