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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
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy
- 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.
- 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
- Bachelor's degree (or higher)
- 1+ year project management experience
- Knowledge of Medicaid/Medicare reimbursement methodologies
- Experience using MS Access
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
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
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