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.

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
•  Responsibilities in this role include, but are not limited to
• Coordinating medical benefits for members and dependents.
• Calling providers, employer groups and clients to obtain pertinent member information.
• Analyzing claim data and calculating refund amounts.
• 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.
• Generally work is self-directed and not prescribed.
• Works with less structured, more complex issues.
• Serves as a resource to others.
  

Requirements:

• Bachelor's Degree
• 2+ Years of Customer Service Experience (Someone who's core position has been on the phone - This person will be calling employer Groups, other Insurance Companies, as well as provider's)
• Work Hours: Monday thru Friday 8 AM to 5 PM (Core Business Hours with OT on a RARE occasion depending on the needs of the client at that time.)
• Intermediate level of proficiency with Excel and Word (This person should be able to complete sorting, summing, and creating bar graphs and formulas within Excel and Be able to create documents and open and read documents)
• 2+ Years Claims/payer knowledge with government and commercial platforms (Someone who has claims experience from working for a hospital, insurance company or healthcare consulting firm)

Assets:

• 3+ years Claims auditing/research experience ((Should have claims expertise and knowledge to a degree that they can recognize inconsistency and data integrity issues)
• Previous contracting experience in a role such as Provider Contracting, Provider Service, or Claims QA
• Experience with Prior Authorization or Medical Reviews
• Healthcare finance experience with a focus in auditing and/or analysis (Someone who can analyze numbers and Identify trends)

Physical Requirements and Work Environment:

• Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouse
• Office environment
  

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.