The Senior Recovery / Resolution Representative handles information about patient services and how those services are paid by investigating and pursuing recoveries through contact with various parties. The representative manages subrogation files, negotiates settlements, and ensures adherence to compliance policies. They are responsible for overseeing overpayments made by UHG and then they ensure that the funds get back to the proper group by working in several databases and having a high integrity for details.
- Provide claims expertise 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, identify trends, and provide reports as necessary
- Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
- Manage subrogation files
- Perform other duties as assigned
- High School Diploma / GED or higher
- 1+ years of claims or collections experience within the healthcare or related industry (Health, Life, Auto, Commercial etc.)
- 1+ years of customer service experience analyzing and solving customer problems
- High proficiency with computer and Windows PC applications (ability to create, edit, copy, send and save documents, correspondence, and spreadsheets in MS Word and Excel)
- 1+ years experience using claims platforms such as UNET, COSMOS, NICE, Facets, Diamond, etc.
- Experience working with Claims and/or Recovery
- 1+ years working experience with processing C&S, M&R or E&I refunds
- Experience working with LBWS and ODAR
- Experience working with subrogation
- Experience with negotiations
- Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods working at a computer
- Service center environment with moderate noise level due to Representatives talking, computers, printers, and floor activity
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: Optum, Healthcare, Recovery, Resolutions, Claims, Customer Service, Telephonic, Collections