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Senior Recovery Resolutions Specialist - Wauwatosa, WI - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Wauwatosa, WI Wauwatosa, Wisconsin |
About this job
Position Description:
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.
The Senior Recovery/Resolution Specialist handles information about patient services and how those services are paid by investigating and pursuing recoveries through contact with various parties. This position manages subrogation files, negotiates settlements, and ensures adherence to compliance policies.
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.
Primary Responsibilities:
The Senior Recovery/Resolution Specialist handles information about patient services and how those services are paid by investigating and pursuing recoveries through contact with various parties. This position manages subrogation files, negotiates settlements, and ensures adherence to compliance policies.
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.
Primary Responsibilities:
- 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
- Extensive work experience, possibly in multiple functions.
- Work does not usually require established procedures.
- Works independently.
- Mentors others.
- Acts as a resource for others.
- Coordinates others' activities.
Requirements
Requirements:
Physical Requirements and Work Environment:
- High school diploma/GED
- 2+ years of claims or collections experience
- 1+ year of customer service experience analyzing and solving customer problems
- 2+ years proficiency with computer and Windows PC applications
- Experience working with subrogation
- Experience with negotiations
- Experience in the Healthcare industry
Physical Requirements and Work Environment:
- 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
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.
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