Position Description:

Flexible? Friendly? Fast on your feet? That's a great start. Accurate? Accountable? Self Directed? These traits can take you places. Our claims operations are the focal point of handling information about services patients receive and they way those services get paid. It's complex, detailed work. It's fast paced challenge. It's a job that calls on you to be thoughtful, resourceful, team-driven and customer-focused. To put it mildly, there is never a dull moment.

Primary Responsibilities:

• Investigate, recover, and resolve all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities
• Initiate phone calls to members, providers, and other insurance companies to gather coordination of benefits
• 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
• Department specific title is QOC Triage Analyst. This job role does not perform claims operations. 
  

*** Telecommuting is available only to current telecommuters. If you are currently are working in an office then you will continue reporting to that office.

Requirements:

• 4+ years experience handling complex issues involving state regulations that impact customer benefits, claims, eligibility, and medical care
• Bachelor's Degree OR high school diploma/GED with at least 4 years of experience with healthcare industry terms and concepts
• Moderate Proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
• Basic skills using Microsoft Word required
• Research skills and familiarity with the Internet
• Ability to work in a quality and metric based environment with several complex projects, short timelines, and involving multiple contributors

Assets:  

• Knowledge of various state regulations impacting appeals and grievances preferred
• Previous Quality of Care (QOC) department experience with systems and processes preferred
• Excel is preferred

UnitedHealthcare, part of the UnitedHealth Group family of companies, is comprised of three specialized businesses dedicated to meeting the health care benefits needs of individuals and groups; all part of something greater, but each with a specialized focus:

UnitedHealthcare Employer & Individual works with individuals, small businesses and large multi-site employers to provide innovative, affordable benefits services.

UnitedHealthcare Medicare & Retirement is focused on serving Americans over the age of 50. It is the largest business dedicated to meeting the growing health and well-being needs of aging individuals in the nation, serving one in five Medicare beneficiaries through a comprehensive and diversified array of products and services through four industry-leading businesses.

UnitedHealthcare Community & State provides high-quality, personalized, public-sector health care programs that help local government agencies improve health outcomes for millions of children and low-income and disabled individuals at an affordable cost.

Together, we're removing the barriers that keep people from receiving the kind of quality health care that makes a difference. We focus on Integrity, Compassion, Relationships, Innovation and Performance as we empower people to achieve better health and well-being.

Come grow and thrive in our culture of innovation and ideas. Because there is no opportunity greater than the quest to help people live healthier lives.

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.