Why Unite Here Health
FY2024 · Form 990Its mission and biggest programs, as filedProvides high-quality, affordable healthcare benefits and administrative support to hospitality workers and their families through union-sponsored Taft-Hartley benefit plans.
- Amounts paid by contributing employers on behalf of members as consideration for providing goods and services of facilities to further the purpose constituting the basis for the exemption of the organization.
- Amounts paid by contributing members as consideration for providing goods and services of facilities to further the purpose constituting the basis for the exemption of the organization.
- Amounts received from affiliated exempt organization for shared administrative expenses to assist in carrying out its exempt purpose.
Before you apply
FY2024 · Form 990Independent: from IRS data, not the orgAbout the role
The org's own posting, as writtenUNITE HERE HEALTH serves 200,000+ workers and their families in the hospitality and gaming industry nationwide. Our desire to be innovative and progressive drives us to develop impactful programs and benefits designed to engage our participants in managing their own health and healthcare. Our vision is exciting and challenging. Please read on to learn more about this great opportunity! The Claims Adjudicator II position will receive, examine, verify and input submitted medical claim data, determine eligibility status, and review and adjudicate claims within established timeframes.
This position utilizes multiple systems in order to perform the day-to-day functions of processing medical, disability, vision and dental claims, as well as, provider and member driven inquiries.
ESSENTIAL JOB FUNCTIONS AND DUTIES Screens claims for completeness of necessary information Verifies participant/dependent eligibility Interprets the plan benefits from the Summary Plan Description (SPD)/Plan Documents Codes basic information and selects codes to determine payment liability amount Evaluates diagnoses, procedures, services, and other submitted data to determine the need for further investigation in relation to benefit requirements, accuracy of the claim filed, and the appropriateness or frequency of care rendered Determines the need for additional information or documentation from participants, employers, providers and other insurance carriers Handles the end to end process of Medicare Secondary Payer (MSP) files Processes Personal Injury Protection (PIP) claims Requests overpayment refunds, maintains corresponding files and performs follow-up actions Handles verbal and written inquiries received from internal and external customers Processes Short Term Disability claims Adjudicates claims according to established productivity and quality goals Achieve individual established goals in order to meet or exceed departmental metrics ESSENTIAL QUALIFICATIONS 3 ~ 5 years of direct experience minimum in a medical claim adjudication environment Working knowledge and experience in interpretation of benefit plans, including an understanding of limitations, exclusions, and schedule of benefits Experience with eligibility verification, medical coding, coordination of benefits, and subrogation and it’s related processes Experience with medical terminology, ICD10 and Current Procedural Technology (CPT) codes Fluency (speak and write) in Spanish, preferred Salary range for this position : Hourly $20.36 - $24.97.
Actual base salary may vary based upon, but not limited to: relevant experience, qualifications, expertise, certifications, licenses, education or equivalent work experience, time in role, peer and market data, prior performance, business sector, and geographic location. Work Schedule (may vary to meet business needs): Monday~Friday, 7.5 hours per day (37.5 hours per week) Fully Remote, after 1-week training onsite in Oak Brook, IL. (Travel and Lodging paid for by UHH)…
About Unite Here Health
From its Form 990- Budget $1.51B
- Staff 535 · founded 1974
- Pays its leaders $299K–$470K (8 reported)
- Open jobs 4 · Jobs at Unite Here Health · Full 990 report