Recovery and Resolution Specialist - San Antonio, TX - Full-time / Part-time

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.(sm)

Primary Responsibilities:

• Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing and adjusting claims


• Authorize appropriate payment or refer claims to investigators for further review


• Analyze and identify trends and provides reports as necessary


• Research paid claims history for overpayments, post incoming live check refunds and withhold payment to collect on refund request that are unfulfilled


• Consistently meet established productivity, schedule adherence, and quality standards


• Provide excellent customer service

Required Qualifications:

• High school diploma or GED, or 10+ years of equivalent working experience


• 2+ years of claims processing experience 


• Medicare claims experience


• ICD9 experience


• Intermediate level of proficiency in MS Word and Excel


• Moderate proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications


• Ability to multi-task, which includes the ability to understand multiple products and multiple levels of benefits within each product

Preferred Qualifications:

• ICD9 Certification


• IKA system knowledge

WellMed is a healthcare delivery system serving more than 90,000 patients, primarily Medicare eligible seniors, in Texas and Florida through primary care clinics, multi-specialty clinics, and contracted medical management services. Headquartered in San Antonio, Texas, WellMed is an industry leader in medical risk management, highly effective disease management and chronic care programs, healthcare delivery services and more.

Our focus and mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. We are innovators in preventative healthcare, striving to change the face of healthcare delivery for seniors. Our providers and support staff are selected for their dedication to the senior population and focus on preventative, proactive patient care.

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: 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.

Job Keywords: ICD9 coding, IKA system, claims processing, Coding Certification, Medicare claims processing, San Antonio, Texas, TX