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 60 million Americans live their lives tothe fullest by educating them about their symptoms, conditions and treatments;helping them to navigate the system, finance their healthcare needs and stay ontrack with their health goals. No other business touches so many lives in sucha positive way. And we do it all with every action focused on our shared valuesof Integrity, Compassion, Relationships, Innovation & Performance.The health care system is still evolving at a rapid pace. Technology is driving new advances in how patient care is delivered and how it's reimbursed. Now, UnitedHealth Group invites you to help us build a more accurate and precise approach to claims adjudication. As part of our Recovery and Resolutions team, you'll help understand and overcome errors in claims processing. You'll have all the tools and backing you need to help manage subrogation files, negotiate settlements and ensure adherence to compliance policies. All the while, you'll be building your career with a leader and reaching for the highest levels of performance as you do your life's best work.This is a challenging role with serious impact. You'll need to sort through complex situations to understand and clarify where errors happened or where they may continue to happen. It's a fast paced environment that takes focus, intensity and resilience.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 filesExtensive work experience, possibly in multiple functionsWork does not usually require established proceduresWorks independentlyMentors othersActs as a resource for othersCoordinates others' activities
Required Qualifications: High School Diploma / GED (or higher) 1+ years of experience within the health insurance industry Experience with computer research Proficiency within Microsoft Excel (pivot tables, v look ups, formulas, filter, sort) Preferred Qualifications: Associate's Degree (or higher) Familiar with CPT code terminology Experience with one or more of the following: claim processing, provider demographic information or insurance billing practices Certified coder Careers 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: UnitedHealth Group, UnitedHealth Care, Health care, insurance, computer research, microsoft excel
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.