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Senior Recovery Resolution Analyst - Franklin, TN
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Franklin, TN Franklin, Tennessee |
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 Analyst will work with a team on researching
issues to determine feasibility of reducing medical costs through
prospective solutions of claim system processes and claim business
rules.
Primary Responsibilities:
- Investigating,
recovering and resolving all types of claims as well as recovery and
resolution for health plans, commercial customers and government
entities - Initiate phone calls to members, providers, and other insurance companies to gather benefit information
- 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
- Coordinating medical benefits for members and dependents
- Calling providers, employer groups and clients to obtain pertinent member information
- Analyzing claim data and calculating refund amounts
- May
include initiating telephone calls to members, providers and other
insurance companies to gather coordination of benefits data - May conduct contestable investigations to review medical history
- May monitor large claims including transplant cases
Requirements
Requirements:
- High School Diploma/ GED
- 2+ years of phone based customer service
- 2+
years claims/ payer knowledge with government and commercial platforms
(claims experience derived from working for a hospital, insurance
company or healthcare consulting firm) - 2+ years of previous contracting experience in a role such as Provider Contracting, Provider Service, or Claims QA
- Intermediate
level of proficiency with Excel and Word (This person should be able to
complete sorting, summing, and creating bar graphs and formulas within
Excel and be able to create documents and open and read documents) - Ability to work during the hours of operation: 8:00am - 5:00pm, Monday - Friday (overtime on rare occasions)
- 3+ years claims auditing/ research experience
- Experience with prior authorization or medical reviews
- Healthcare finance experience with a focus in auditing and/ or analysis (Ability to analyze numbers and Identify trends)
- Extended periods of sitting at a computer and use of hands/ fingers across keyboard or mouse
- Office environment
Careers with OptumInsight.
Information and technology have amazing power to transform the health
care industry and improve people's lives. This is where it's happening.
This is where you'll help solve the problems that have never been
solved. We're freeing information so it can be used safely and securely
wherever it's needed. We're creating the very best ideas that can most
easily be put into action to help our clients improve the quality of
care and lower costs for millions. This is where the best and the
brightest work together to make positive change a reality. This is the
place to 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, national origin, protected veteran status, or disability status.
UnitedHealth
Group is a drug-free workplace. Candidates are required to pass a drug
test before beginning employment. In addition, employees in certain
positions are subject to random drug testing.
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