Positions in this function are responsible for investigating, recovering and resolving all types of claims as well as recovery and resolution for health plans, commercial customers and government entities. May include initiating telephone calls to members, providers and other insurance companies to gather coordination of benefits data. Investigate and pursue recoveries and payables on subrogation claims and file management. Process recovery on claims. Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance. May conduct contestable investigations to review medical history. May monitor large claims including transplant cases.
- Provide expertise claims support by reviewing, researching, investigating, negotiating and resolving all types of claims as well as recovery and resolution for health plans, commercial customers and government entities
- Analyze and identify trends and provides reports as necessary
- Identifies members who have duplicate coverage or have been injured and are pursuing a claim for damages
- Responsible for processing COB / Subrogation pended claims and electronic inquiries within company / department standards
- Works with providers, members, attorneys, other legal staff and third-party carriers regarding questions, problems or information
- Create and follow-up cases for possible third-party recovery, including contacting attorney / insurance carrier. Includes reviewing claims, generating letters
- Process / distribute incoming checks: update / complete the case file and documentation
- Review of monthly member past term reports, with verification of termination date and appropriate recovery steps based on company guidelines
- Process all overpayments identified by claims processing staff, COB staff, Subrogation staff and all Member Services Departments
- Maintaining recovery follow-up inquiries 30 days after initial letter if no response or payment received
- Interact with providers and / or members that are requesting details regarding the overpayments and / or desiring to set up payment plans
- Extensive work experience within own function
- Work is frequently completed without established procedures
- Works independently
- May act as a resource for others
- May coordinate others' activities
- HS Diploma / GED or higher
- 1+ years of experience in claims recovery and resolution
- Proficiency with a computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
- Knowledge of Subrogation, third party benefits and recovery
- Ability to create, copy, edit, send, and save spreadsheets in Excel. The ability to work in a Microsoft Access database.
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.