Sr Recovery / Resolution Analyst – US Telecommute

UnitedHealth Group
Published
August 29, 2020
Location
Houston, TX
Category
Job Type

Description

Welcome to one of the toughest and most fulfilling ways tohelp people, including yourself. We offer the latest tools, most intensivetraining program in the industry and nearly limitless opportunities foradvancement. Join us and start doing yourlife'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. 

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.

  • Generally, work is self-directed and not prescribed
  • Works with less structured, more complex issues
  • Serves as a resource to others
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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 pursue recoveries and payables on subrogation claims and file management 
  • Initiate phone calls to members, providers, and other insurance companies to gather coordination of benefits information
  • Process recovery on claims 
  • 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 

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. 

Required Qualifications: 
  • High school diploma / GED (or higher)
  • Coding certification (any of the following:  CPC, CPC-H, CPC-P, CCA, CCS, CCS-P, RHIT, or RHIA), or an RN or LPN license 
  • Experience working with medical claims platforms
  • 2+ years of experience with claims auditing and researching claims information
  • 1+ year of experience analyzing data and identify cost saving opportunities
  • Knowledge of claims processing systems and guidelines/processes
  • Intermediate skills with Excel
  • Experience in healthcare
Preferred Qualifications:
  • Bachelor's degree (or higher)
  • 1+ year project management experience
  • Knowledge of Medicaid/Medicare reimbursement methodologies
  • Experience using MS Access
Telecommuting Requirements:
  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
  • Ability to keep all company sensitive documents secure (if applicable)
  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
Careers with OptumInsight. Information andtechnology have amazing power to transform the Healthcare industry and improvepeople's lives. This is where it's happening. This is where you'll help solvethe problems that have never been solved. We're freeing information so it canbe used safely and securely wherever it's needed. We're creating the very bestideas that can most easily be put into action to help our clients improve thequality of care and lower costs for millions. This is where the best and thebrightest work together to make positive change a reality. This is the place todo your life’s best work.SM

Diversity creates a healthier atmosphere: UnitedHealth Groupis an Equal Employment Opportunity / Affirmative Action employer and allqualified applicants will receive consideration for employment without regardto race, color, religion, sex, age, national origin, protected veteran status,disability status, sexual orientation, gender identity or expression, maritalstatus, genetic information, or any other characteristic protected by law.

UnitedHealth Groupis a drug - free workplace. Candidates are required to pass a drug test beforebeginning employment.

 

Keywords: Claims Recovery, Resolution Analyst, Telecommute, Remote, Work from Home

What we do defines who we are. Take a deeper look at howwe're providing support during this global health crisis and search for a wayyou can get involved. View our Covid-19 Resources Page at: https://info.uhg.com/

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