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
• Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance
• Call Center Environment : Must have the ability to stick to a strict schedule
• 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.
  

• High School Diploma/GED is required
• 2+ years of healthcare experience
• 1+ years Medical Insurance background is required
• 1+ year of customer service experience;
•  Intermediate level of proficiency with MS Excel
• Must be able to work the hours between 7AM to 7PM

Assets:

• Knowledge of UNET, COSMOS, FACETS, OXFORD, Diamond and/or NICE is preferred
• Experience in medical claims and/or adjustments
• Experience within an Collector role; i.e. someone who has previously or is currently working within a collector capacity
• Customer service experience in a healthcare and/or call center environment is preferred

OptumInsight is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.

OptumInsight is one of the largest and fastest growing health information companies. We specialize in improving the performance of the health system by providing analytics, technology and consulting services that enable better decisions and results. We integrate workflow solutions that deliver data in real-time, and create actionable insights - processing health information that relates directly to and affects one in four patients in the U.S, one in every three Medicaid dollars and one in every five emergency room visits. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.

What can YOU do with the right information? At OptumInsight, the possibilities and the impact are limitless. No matter what your role is at OptumInsight, you'll be empowered to ask more questions, develop better solutions and help make the health care system greater than ever. It's always fresh. It's always exciting. And it's never been more important.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.