Recovery/Resolutions Representative - US Telecommute - 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 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 support by reviewing and preparing medical records for claims
investigators.  Navigate
through systems/platforms; gather, prepare and input information into the
case tracking data bases; forward cases to the assigned claims
investigator mailbox. Review,
research, and investigate incomplete and unresolved claims records.Analyze,
identify, and report trends.Provide
other support services assistance as requested.Meet
required metrics and quality.Ensure
adherence to state and federal compliance policies, and contractual
requirements.    Extensive
work experience within own function.Work
is frequently completed without established procedures.Works
independently.Act
as a resource for others.May
assign claims records within the team.

Required
Qualifications:

High
School Diploma or GEDBeginner
level of proficiency with MS Outlook and Excel (creating, saving,
formatting documents.) 8 AM
to 4:30 PM, Monday - Friday

Preferred
Qualifications:

Bachelor's
Degree (or higher)1+
years of experience working in an Administrative/Data Entry role in a
production environmentPrevious
Healthcare experience

Physical
Requirements and Work Environment:

Extended
periods of sitting at a computer and use of hands/fingers across keyboard
or mouse



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:
claims, medical claims, healthcare claims, claims processing, claims
processor; office, UnitedHealth Group, Optum,  training class, customer
service representative, customer service, CSR, Data Entry, adjustments,
phone support