Position Description:Energizeyour career with one of Healthcare's fastest growing companies. Youdream of a great career with a great company – where you can make an impact andhelp people. We dream of giving you theopportunity to do just this. And withthe incredible growth of our business, it's a dream that definitely can cometrue. Already one of the world's leading Healthcare companies, UnitedHealthGroup is restlessly pursuing new ways to operate our service centers, improveour service levels and help people lead healthier lives. We live for the opportunity to make adifference and right now, we are living it up. Thisopportunity is with one of our most exciting business areas: Optum –a growingpart of our family of companies that make UnitedHealth Group a Fortune 6 leader. Optum helps nearly 60million Americans live their lives to the fullest by educating them about theirsymptoms, conditions and treatments; helping them to navigate the system,finance their healthcare needs and stay on track with their health goals. Noother business touches so many lives in such a positive way. And we do it allwith every action focused on our shared values of Integrity, Compassion,Relationships, Innovation & Performance.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.The Senior Recovery Resolutions 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 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 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 Analyze, identify trends, and provide reports as necessary Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance Manage subrogation files 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 Extensive work experience, possibly in multiple functions. Work does not usually require established procedures Works independently Mentors others Acts as a resource for others Coordinates others' activities
Required Qualifications:High School Diploma / GED (or higher)1+ years of customer service experience analyzing and solving customer problemsPrevious claims or collections experienceExperience working in the healthcare industryProficiency with computer and Windows PC applicationsPreferred Qualifications:Experience working with subrogationExperience with negotiationsPhysical Requirements and Work Environment:Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, long periods working at a computerService center environment with moderate noise level due to Representatives talking, computers, printers, and floor activityCareers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do 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: Recovery, Resolutions , UHG, Frederick, Maryland
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.