Stop Loss Recovery Representative - Wausau, WI, Onalaska, WI and San Antonio, TX - Full-time / Part-time

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.

Positions in this function are
responsible for managing and participating in qualification, investigation,
recovery and resolution of all types of stop loss claims for ASO Clients with
Specific and Aggregate Stop Loss Contracts administered by UMR. Activities may
include initiating telephone calls to members, employers, providers and other
third parties to gather claim qualifying information. Inquiries and
collaboration is required with Claim Operations, Care Management, Legal, and
Reporting. Client or Broker presentations of case activities or report
information may be involved. Ability to review and make gap comparisons between
Employer Plan documents and Stop Loss contracts is required. Claim experience
on CPS is preferred.

 

Primary Responsibilities:

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
necessaryEnsure adherence to state and federal compliance
policies, reimbursement policies and contract complianceDevelop information sources to complete weekly claim
filings for Stop Loss.Maintain prescription drug detail for customers that
include this coverage in specific or aggregate contracts.Recording reimbursements received and sending checks to
the customer.Provide for follow-up requests from Stop Loss Carriers.Develop understanding of Stop Loss and Plan Sponsor
Policy and Contract language and the relationship this has to Claim
Filings.Managing end to end process of filing for Aggregate
reimbursement requests.Solicit requirements from several sources including
Claim Systems, Reporting Systems, direct contacts with Claim and
Eligibility Teams, and direct contact with Providers.Provide insights on claim issues with Sales and
Broker personnel

Requirements:High School Diploma or GED2+ years of experience  in a claims or customer service role in the Healthcare or Insurance  industry2+ years of basic proficiency with MS Word Assets:Associate's or Bachelor's DegreeKnowledge of Insurance policy and contract language Experience with processing medical claimsExperience with the UMR CPS Claims Payment system Strong math skills Basic proficiency with MS Power Point, Excel and Access Physical Requirements and Work Environment:Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouseCareers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is 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.