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Hours Full-time, Part-time
Location Franklin, TN
Franklin, Tennessee

About this job

This may be the time to expand your claims expertise and your career. Training classes designed to support you are starting soon, so don’t wait to apply. 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.As a Senior Recovery/Resolution Analyst you’ll work with an elite team on researching issues to determine the feasibility of reducing medical costs through prospective solutions of claim system processes and claim business rules. You’ll be responsible for investigating, recovering and resolving all types of claims as well as recovery and resolution for health plans, commercial customers and government entities. This may include initiating telephone calls to members, providers and other insurance companies to gather coordination of benefits data. You’ll investigate, pursue, and process recoveries and payables on subrogation claims and file management. Throughout your work, you’ll ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance. In addition you may conduct contestable investigations to review medical history and monitor large claims including transplant cases. This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8 hour shift schedules during our normal business hours of (7:00am-6:00pm). It may be necessary, given the business need, to work occasional overtime or weekends. Our office is located at 1009 Windcross CT, Franklin, TN 37067.Responsibilities:Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimizationInvestigate, recover, and resolve all types of claims as well as recovery and resolution for health plans, commercial customers, and government entitiesInvestigate and pursue recoveries and payables on subrogation claims and file managementInitiate phone calls to members, providers, and other insurance companies to gather coordination of benefits informationProcess recovery on claimsEnsure adherence to state and federal compliance policies, reimbursement policies, and contract complianceUse pertinent data and facts to identify and solve a range of problems within area of expertiseAbility to identify and understand the data needs of a growing organizationStructure and prepare analysis to support and lead decision makingStrong verbal and written communication skillsStrong interpersonal skills and ability to interact with multiple departments and managementAbility to prioritize timeWork on multiple tasks with ongoing deadlinesGenerally work is self-directed and not prescribedWorks with less structured, more complex issuesServes as a resource to othersUndergraduate degree is strongly preferred in Business, Statistics, Computer Science, Accounting or related field

Requirements

High school diploma or GED1+ years of experience with claims auditing and researching claims informationIntermediate skills with MS ExcelExperience in healthcare industryPreferred Qualifications:An undergraduate degree or higher1+ year project management experienceKnowledge of Medicaid/Medicare Reimbursement methodologiesKnowledge of claims processing systems and guidelines/processes1 year experience with claims processing systems such as CSP, FACETS, UNISON, or DIAMOND1+ year of experience analyzing data and identify cost saving opportunities2+ years’ experience performing financial analysis, reporting and building knowledge of statistical calculation and interpretationPhysical 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 activityThere are several steps in our hiring process - it’s a thorough process because we want to ensure the best job and culture fit for you and for us. In today’s ultra-competitive job market, the importance of putting your best foot forward is more important than ever. And you can start by completing all required sections of your application. (i.e. profile, history, certifications and application/job questions). Once you submit your resume, you’ll receive an email with next steps. This may include a link for an on-line pre-screening test that we ask you to complete as part of our selection process.  You may also be asked to complete a digital video interview, but we will offer full instructions and tips to help you. After you have completed all of these steps, you can check on the status of your application at any time, but you will also be notified via e-mail.http://uhg.hr/OurApplicationProcessCareers 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.SMDiversity 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, UnitedHealthcare,  training class, customer service representative, customer service, CSR, Data Entry, adjustments, phone support