Position Description: Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.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. 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.Identifies members who have duplicate coverage or have been injured and are pursuing a claim for damages.Responsible for processing COB / Subrogation pended claims and electronic inquiries within company / department standards.Works with providers, members, attorneys, other legal staff and third-party carriers regarding questions, problems or information.Create and follow-up cases for possible third-party recovery, including contacting attorney / insurance carrier. Includes reviewing claims, generating letters.Process / distribute incoming checks: update / complete the case file and documentation.Review of monthly member past term reports, with verification of termination date and appropriate recovery steps based on company guidelines.Process all overpayments identified by claims processing staff, COB staff, Subrogation staff and all Member Services Departments.Maintaining recovery follow-up inquiries 30 days after initial letter if no response or payment received.Interact with providers and / or members that are requesting details regarding the overpayments and / or desiring to set up payment plans.Extensive work experience within own function.Work is frequently completed without established procedures.Works independently.May act as a resource for others.May coordinate others' activities.
Required Qualifications: High School Diploma / GED required1+ years of experience in claims recovery and resolution Moderate proficiency with a computer and Windows PC applications, which includes the ability to learn new and complex computer system applicationsCareers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of healthcare. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work. Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Keywords: UnitedHealth Group, UnitedHealth care, Health Care, Recovery, Claims, resolution, windows PC, audit
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.