Recovery Resolution Consultant - Telecommute - Full-time / Part-time

Position Description:

Recovery/Resolution Consultant is responsible for managing prospective claims savings to ensure cost avoidance financial goals are met. The COB Recovery/Resolution Consultant high level focus is on the financial impact / cost savings to UHG, efficiency of COB processes, and compliance with state and federal requirements.

Primary Responsibilities:

• Design, author, develop, modify, and execute SQL queries to attain an end result
• Maintain a high level of attention to detail and validation efforts on each script completed
• Develop operational documentation that includes workflow use cases, context diagrams, requirements documents, operational support documentation, test cases and training material
• Monitor program monthly financial status by comparing and analyzing forecast saving against actual results to ensure financial goals are met
• Seek out and lead project opportunities to drive the identification of new COB information and the improvement of COB processes
• Take leadership and ownership of existing projects to maximize COB cost avoidance
• Work collaboratively with COB SMEs, operational teams and management, health plan representatives, and other external and internal partners
• Lead internal/external vendor activity by driving work effort and/or providing Subject Matter Expert's (SME)
• Track vendor and internal operational team quality of work, performing audits as needed
• Work with internal operational teams (COB Ops) to manage cost avoidance loading and validation process
• Research escalated COB issues and concerns, to identify root causes of problems or explain misinterpretations of COB outcomes
• Drive file crosswalk and/or mapping projects
• Represent department in IT and business initiatives
• Represent department in internal/external audits
• Research COB Encounter rejects
• Research cost avoidance reconciliation issues
• Research escalated COB issues and concerns, to identify root causes of problems or explain misinterpretations of COB outcomes

Requirements:

• Bachelor degree or equivalence in work history in a project management, business analysis or claims management role.
• 4+ years heavy SQL writing and analysis
• 3+ years of advanced Excel experience, including competencies in VBA, Microsoft Query, and external data connections.
• 3+ years Business Analytics experience
• 3+ years Data Analytics experience
• Claims exposure experience
• Medicare and/or Medicaid facility claims exposure experience
• 3+ years experience working within a relational database

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.

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.