About UHG

Careers at UnitedHealth Group


We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM


Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com


Job Category:




Approximate Salary:

Not Specified

Position Type:

Full Time

Recovery / Resolution Analyst - Pittsburgh, PA

UHG - Pittsburgh, Pennsylvania

Posted: 12/10/2018

The health care system is still evolving at a rapid pace. Technology is driving new advances in how patient care is delivered and how it's reimbursed. Now, UnitedHealth Group invites you to help us build a more accurate and precise approach to claims adjudication. As part of our Recovery and Resolutions team, you'll help understand and investigate Optum Waste and Error stopped claims by gathering information, researching state and federal guidelines, and following internal procedure to determine the viability of the claim for further review in a production environment. All the while, you'll be building your career with a leader and reaching for the highest levels of performance as you do your life's best work.SM

Primary Responsibilities: 

  • Effectively handle their production caseload, monitor mandated and internal turn - around time requirements
  • Follow Department Standards Operating Procedures and Policies
  • Communicate Claim Processing instruction
  • Outbound calls to provider offices
  • Co - owner of SME mailbox; respond to emails and resolve issues in compliance with service level
  • Provide continuous availability for questions and assistance to team members
  • Respond to all questions from assigned peer team members, management and internal clients with regards to internal process and procedures in a timely manner
  • Co - facilitate new hire and ongoing training opportunities for team members
  • Assist Manager and BA with job aid updates
  • Performing a demonstration of the daily job responsibilities
  • Performing daily audits on work completed by the new team members to ensure understanding of policies and procedures of the department

Required Qualifications:

  • High School Diploma / GED (or higher)
  • 1+ years of claims experience (processing, research or adjustments)
  • Ability to navigate Microsoft Office Applications: Microsoft Word (ability to create / edit document); Microsoft Excel (VLOOKUP and formulas)
  • Experience working in the healthcare industry

Preferred Qualifications:

  • Associate’s Degree or higher OR relevant healthcare insurance experience
  • 1+ years of claims operations experience
  • Experience using claims platforms such as COSMOS, CPW, NICE, Facets
Soft Skills:
  • Excellent communication skills

UnitedHealth Group is a team of more than 260,000 people who are building career success through commitment, compassion and a desire to make a difference. Join us. Learn more about how you can start doing your life's best work.SM

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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

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.

Keywords: claims, FWAE, processing, research, adjustment, fraud, waste, error, cost saving, data integrity, process optimization, data security, data analyst, Excel, Vlookup

Apply Now