Claims Adjustment Specialist - Kelsey Seybold Clinic - Pearland 2386448 | Pearland, Texas | Kelsey-Seybold Clinic | Remote

Claims Adjustment Specialist - Kelsey Seybold Clinic - Pearland Requisition number: 2386448 Job category: Claims Primary location: Pearland, Texas Date posted: 09/23/2026 Overtime status: Non-exempt Travel: No Share this job Facebook X LinkedIn Email Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together. If you are located in Houston, Texas and have the ability to go to office for meetings / etc., you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities: 45% Claims Review & Adjustment: Review claims requiring correction due to processing errors, updated documentation, or system changes Analyze claim history, benefit plans, and prior adjudication to determine appropriate adjustments Perform claim corrections, reversals, and reprocessing in accordance with internal policies and regulatory guidelines Validate accurate payment or denial outcomes following adjustments 25% Investigation & Resolution: Investigate discrepancies, missing information, or inconsistencies impacting claim outcomes Ensure all actions are clearly documented within the claims system Provide clear, accurate explanations regarding adjustment decisions when required Investigate Data Mining results for potential recovery adjustments 15% Cross-Functional Collaboration: Partner with Claims Processing, Quality Assurance, Training, Escalations, Customer Service, and Appeals teams to resolve issues Support escalated or complex claim scenarios requiring coordination across departments 10% Quality & Process Improvement: Identify trends, root causes, and recurring issues contributing to preventable errors Provide feedback and recommendations to improve first-pass claim accuracy and operational efficiency 5% Other: Participate in department initiatives and special projects as assigned by leadership Provide subject matter expertise for training, process improvements, and system enhancements Support cross-functional collaboration with Claims, Regulatory, Quality, and Audit teams to achieve departmental goals 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 GED 2+ years of claims adjudication experience in an HMO, PPO, or TPA environment Working knowledge of claim adjudication workflows and benefit interpretation Proficiency with Microsoft Office Suite (Excel, Word, Outlook) and spreadsheet tracking Proven excellent written and verbal communication skills Proven ability to interpret claim data, supporting documentation, and payer requirements Proven ability to work independently while managing multiple priorities Demonstrated solid attention to detail with the ability to ensure accuracy and completeness of work Demonstrated solid documentation and organizational skills Demonstrated professionalism, accountability, and compliance mindset Preferred Qualifications: Experience specifically in claims adjustments, retro-processing, or complex claim review Experience with claims systems such as EPIC, Centricity, or similar platforms Experience participating in audit readiness, QA reviews, or error-prevention initiatives Familiarity with HIPAA requirements, state mandates, and payer-specific rules Prior collaboration with Quality, Training, or Audit teams *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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $20 - $36 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 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. 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. Apply Internal apply Bookmark job Back to nav Benefits Our mission of helping people live healthier lives extends to our team members. Learn more about our range of benefits designed to help you live well. Life Resources and support to focus on what matters most to you, in every facet of your life. Emotional Education, tools and resources to help you reduce and manage stress, build resilience and more. Physical Health plans and other coverage to support wellness for you and your loved ones. Financial Benefits for today and to help you plan for the future, including your retirement. Learn more Back to nav Previous slide Being able to connect with so many people that all have the same goal in giving the best care possible is something truly special. Brooke G. Senior Pharmacy Technician At Optum, I receive the support, resources, and flexibility that I want so that I can be the best doctor possible while also finding personal and professional satisfaction. Dr. Conan T. Regional Chief of Primary Care We’re applying artificial intelligence to build something that can help people in their most distressed moments. The problems you work on here have an impact on someone’s life. Achala S. Senior Director and AI Architect Being able to connect with so many people that all have the same goal in giving the best care possible is something truly special. Brooke G. Senior Pharmacy Technician At Optum, I receive the support, resources, and flexibility that I want so that I can be the best doctor possible while also finding personal and professional satisfaction. Dr. Conan T. Regional Chief of Primary Care We’re applying artificial intelligence to build something that can help people in their most distressed moments. The problems you work on here have an impact on someone’s life. Achala S. Senior Director and AI Architect Being able to connect with so many people that all have the same goal in giving the best care possible is something truly special. Brooke G. Senior Pharmacy Technician Next slide Go to slide 1 Go to slide 2 Go to slide 3 Back to nav We’re honored to be recognized for our exceptional work culture