Position Description: Energize your career with one of Healthcares fastest growing companies. You dream of a great career with a great company - where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, its a dream that definitely can come true. Already one of the worlds leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up. This opportunity is with one of our most exciting business areas: Optum - a growing part of our family of companies that make UnitedHealth Group a Fortune 17 leader. Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation and Performance. The Senior Recovery / Resolution Representative handles information about patient services and how those services are paid by investigating and pursuing recoveries through contact with various parties. Primary Responsibilities:
Provide claims expertise 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
Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
Perform other duties as assigned
Develops and expands knowledge of COB Rules, basic computer skills and business etiquette
Performs basic and specialty workflow and administrative tasks with minimal supervision
Collaborates with others to identify and solve moderate problems and create procedures that promote efficiency and quality
Initiates telephone calls to members, providers and other insurance companies to gather COB data
Receives and respond to incoming telephone inquiries
Determines primacy using published COB
Updates eligibility system / database with outcome of primacy investigation
Documents and communicates outcome of investigation following departmental procedures
Meets productivity, quality and timeliness goals
Responds to routine or standard requests to meet customer needs
Focuses on customer; exceeds expectations and improves customer experience
Makes fact-based decisions; uses sound judgment and applies business knowledge
Acts ethically; demonstrates integrity, complies with all laws, regulations and policies
UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.
We are committed to introducing innovative approaches, products and services that can improve personal health and promote healthier populations in local communities. Our core capabilities... in clinical care resources, information and technology uniquely enable us to meet the evolving needs of a changing health care environment as millions more Americans enter a structured system of health benefits and we help build a stronger, higher quality health system that is sustainable for the long term.
We serve our clients and consumers through two distinct platforms:
?UnitedHealthcare, which provides health care coverage and benefits services.
?Optum, which provides information and technology-enabled health services.