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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. The representative manages subrogation files, negotiates settlements, and ensures adherence to compliance policies.
Positions in this function are responsible for 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. Primary Responsibilities:
Provide claims expertise support by reviewing, researching, investigating and resolving all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities
Analyze, identify trends, and provide reports as necessary
Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
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.