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Hours Full-time, Part-time
Location Miami, FL
Miami, Florida

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.SMThe Optum SIU Pre-Pay Investigator 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:Analyzes and investigates.Provides explanations and interpretations within area of expertise.Positions in this function are responsible for investigating, preventing payment and resolving all types of claims as they relate to fraud and abuse. May include initiating telephone calls to members, providers and other insurance companies to gather information pertinent to the case.Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance.May conduct contestable investigations to review medical history.

Requirements

Requirements:Associate's Degree in Criminal Justice or HSD/GED with 2+ years of experience in health insurance claims2+ years of experience within the health insurance claims industryExperience with one or more of the following: claim processing, provider demographic information or insurance billing practicesExperience inputting, editing, sorting and filtering data in Microsoft Excel Experience creating and editing documents in MS Word    Assets:Professional certification as a Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or similarFamiliar with CPT code terminologyExperience with computer researchPhysical 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 computerService center environment with moderate noise level due to Representatives talking, computers, printers, and floor activityCareers 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.