Recovery Or Resols Representative

Optum is a global organization that delivers care aided by technology to help millions of people live healthier lives The work you do with our team will directly improve health outcomes by connecting people with the care pharmacy benefits data and resources they need to feel their best Here you will find a culture guided by inclusion talented peers comprehensive benefits and career development opportunities Come make an impact on the communities we serve as you help us advance health optimization on a global scale Join us to start Caring Connecting Growing together 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 Work is frequently completed without established procedures Primary Responsibilities Provide expertise claims support by reviewing researching investigating negotiating and resolving all types of claims as well as recovery and resolution for health plans commercial customers and government entities Analyze and identify trends and provides reports as necessary Ensure adherence to state and federal compliance policies reimbursement policies and contract compliance May act as a resource for others May coordinate others activities Comply with the terms and conditions of the employment contract company policies and procedures and any and all directives such as but not limited to transfer and or re-assignment to different work locations change in teams and or work shifts policies in regards to flexibility of work benefits and or work environment alternative work arrangements and other decisions that may arise due to the changing business environment The Company may adopt vary or rescind these policies and directives in its absolute discretion and without any limitation implied or otherwise on its ability to do so Required Qualifications High school diploma or GED OR 10 years of equivalent working experience 4 years of experience in claims recovery and resolution Extensive work experience within own function Moderate proficiency with computer and Windows PC applications which includes the ability to learn new and complex computer system applications Proven ability to multi-task this includes ability to understand multiple products and multiple levels of benefits within each product Proven ability to work independently Physical Requirement and Work Environment Extended periods of sitting at a computer and use of hands fingers across keyboard or mouse At UnitedHealth Group our mission is to help people live healthier lives and make the health system work better for everyone We believe everyone-of every race gender sexuality age location and income-deserves the opportunity to live their healthiest life Today however there are still far too many barriers to good health which are disproportionately experienced by people of color historically marginalized groups and those with lower incomes We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission