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Recovery/Resolutions Analyst - Omaha, NE - Full-time / Part-time
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Omaha, NE Omaha, Nebraska |
About this job
Position Description:
The Recovery/Resolution Analyst handles information about patient services and how the services are paid by investigating and pursuing recoveries through contact with various parties. The representative 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:
- Investigate, recover, and resolve 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 coordination of benefits
- 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
- Perform other duties as assigned
- Previous experience working in a metric based environment
- Claims processing background an asset
- Analyzes and investigates.
- Provides explanations and interpretations within area of expertise.
Requirements
Requirements:
- Undergraduate Degree or High School Diploma/GED WITH 2+ years equivalent experience.
- 1+ year experience using claims platforms such as UNET, Pulse, NICE, Facets, Diamond, etc .
- Intermediate level of Microsoft Excel
- Basic level of Microsoft Word, Outlook, and PowerPoint
- Basic experience with computers and Windows PC
- 2+ years experience working in the healthcare industry
- 2+ years experience working with claims and/or recovery
- 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.