Senior Recovery and Resolutions Analyst - Ontario, CA

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.(sm)
 
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 including 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.
 
 
Primary Responsibilities:


Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization

Investigate, recover, and resolve all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities

Investigate and process recoveries and account payables on subrogation claims and workers’ compensation file management

Initiate phone calls to members, providers, and other insurance companies to gather coordination of benefits information

Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance

Use pertinent data and facts to identify and solve a range of problems within area of expertise

Responsible for communicating, disputing and negotiating subrogation claims with legal entities  

Research and Compliance of copy service requests including Legal Summons and Complaints, Subpoenas and Authorizations

Self-motivated, Team Player, able to work with minimal supervision and communicate effectively with patients, outside agencies / vendors

Must be able to multi task; handle challenging, time sensitive, sometimes stressful job responsibilities

Required Qualifications:


High school diploma or GED

2+ years of Experience working with in the health care industry medical claims platform

2+ years of experience in the area of health insurance billing, auto insurance, workers compensation, subrogation and claims / recovery

2+ years of experience analyzing data and identify cost saving opportunities

Knowledge of Medical Terminology, claims processing systems and guidelines

Intermediate skills with Excel, MS Access and Word

2+ years of project management experience

Knowledge of Medicaid / Medicare Reimbursement methodologies

Bilingual
  
Physical 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 computer

Service center environment with moderate noise level due to Representatives talking, computers, printers, and floor activity
  
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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)
 
North American Medical Management, California, Inc. (NAMM California) partnered with OptumHealth in 2012. NAMM California and OptumHealth share a common goal of bringing patients, physicians, hospitals and payers closer together in the mission to increase the quality, efficiency and affordability of care. NAMM California is a part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. NAMM California develops and manages provider networks, offering a full range of services to assist physicians and other providers in supporting patient care coordination and their managed care business operations. For over 18 years, NAMM California has been an innovator in health care with a track record for quality, financial stability, extraordinary services and integrated medical management programs. NAMM California is well positioned to continually invest in its infrastructure and systems for the benefit of its provider clients and to accommodate the impending changes that will come forth from healthcare reform.
 
The NAMM California provider clients represent a network of almost 600 primary care physicians and over 3,000 specialists and work with the premier hospitals in their respective markets.
 
 
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.