[Hiring] Claims Adjustment Representative REMOTE USA

Position: Claims Adjustment Representative

Date Posted: September 21, 2025

Industry: Healthcare / Insurance

Employment Type: Full Time

Experience: 6+ months of claim processing, medical, or insurance experience

Qualification: High School Diploma / GED OR equivalent work experience

Salary: $17.74 – $31.63 per hour

Location: United States, REMOTE

Company: United Healthcare

Description:
ABOUT THE ROLE
UnitedHealthcare is seeking a Claims Adjustment Representative to join our team in a national remote capacity. In this role, you’ll play a critical part in simplifying the healthcare experience, improving community health outcomes, and supporting the processing of claims accurately and efficiently. This is a full-time position (40 hours/week), Monday through Friday, with flexible 8-hour shifts within normal business hours (8:00am – 5:00pm CST). Occasional overtime may be required.

Training:

• 15 weeks of paid virtual training, Monday – Friday, 8:00am – 4:30pm CST
• 100% attendance during training is required

Primary Responsibilities:

• Update claims information following research and communications with providers, health plans, or state compliance offices
• Perform claim adjustments ensuring correct benefits are applied using established processes, including CMS/Medicare/Medicaid guidelines
• Communicate with health plans and internal partners to resolve claim issues clearly and accurately
• Leverage new systems and resources to ensure proper claims processing
• Meet claim turnaround times and metric deliverables
• Conduct data entry, rework, trend analysis, and daily reporting in a high-volume claims environment

Required Qualifications:

• 6+ months of claim processing or insurance/medical experience
• Knowledge of Medicare/Medicaid processes
• Proficiency in Windows 365 applications and ability to learn new software
• Ability to work full-time and flexible shifts

Preferred Qualifications:

• 1+ years experience with Medicaid and Medicare regulations
• 2+ years experience processing claims or reworks
• Experience with Facets (CSP Platform) and Work Distribution Application
• Intermediate Microsoft Teams, Outlook, PowerPoint, and Excel skills

Telecommuting Requirements:

• Maintain a dedicated work area with information privacy
• Secure high-speed internet connection
• Adhere to UnitedHealth Group’s Telecommuter Policy

Soft Skills:

• Strong written and verbal communication to explain complex insurance terms clearly
• Detail-oriented, solution-driven, critical thinker, and results-focused

Benefits:

• Comprehensive benefits package including health, equity, 401(k), incentives, and recognition programs
• Competitive hourly pay based on experience and qualifications
• Career development opportunities within a diverse and equitable workplace

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