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Job Details

UnitedHealth Group

Claims Examiner 2 - Hybrid in Ontario, CA


Medical Examiner


Ontario, California, United States

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

If you are located within Ontario, CA you will have the flexibility to work remotely* as you take on some tough challenges

Processing of medical claims including verification, adjudication and accuracy.

Primary Responsibilities:

  • Accurately process professional claims
  • Responsible for editing and adjusting of claims per the EDI daily audit report
  • Analyze and adjudicate claims to ensure accurate payment
  • Interpret Fee for Service (FFS) and capitated provider contracts
  • Review claims on a periodic basis
  • Meet Department Quality of 98.50% or better on a weekly and monthly basis. Meet production standard of 350 claims per day
  • Interfaces with other departments such as eligibility, UM, Configuration to obtain necessary information required for resolution of claims
  • Advise management of any claim issues or inappropriate and/or incorrect billing
  • Other duties assigned by management

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 General Education Degree (GED); or 3+ months related experience and /or training
  • 2+ years of experience as a Medical Claims Examiner
  • Experience in contract interpretation
  • Working knowledge of Medical Terminology, ICD9, CPT4, UB92/1500 forms
  • Medical Insurance Industry processing
  • Excellent 10 key Data Entry skills

Preferred Qualifications:

  • 1+ years of experience of Institutional claims processing
  • Prior Medicare, HMO experience
  • CPT and HCPCS coding skills
  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Physical Demands The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Normal office environment. May be subject to temperature variations in the office. Occasional early morning, evening or weekend work. Occasional pressure due to multiple calls or interruptions.


Work telecommute work in the office Monday and Thursday 7:00am to 3:30

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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.