Reclamation Team Lead
About The Position
This position follows a hybrid schedule with 3 - 4 in-office days per week. Our office is located at 100 Airpark Center East, Nashville, TN 37217. Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together. The Reclamation Team Lead will work with a team on researching issues to determine feasibility of reducing medical costs through prospective solutions of claim system processes and claim business rules. This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am – 6:00 pm. It may be necessary, given the business need, to work occasional overtime. We offer paid training. The hours during training will be 8:00 am - 6:00 pm, Monday - Friday. You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Requirements
- High school diploma / GED or equivalent work experience
- Must be 18 years or older
- 1+ years of experience analyzing data and identifying cost saving opportunities OR relevant college courses including economics, statistics, data science, or finance
- Experience in healthcare industry
- Knowledge of medical claims Electronic Data Interchange (EDI) workflows including experience in identifying, researching, and resolving EDI claim errors and rejections
- Knowledge of claims processing systems and guidelines/processes
- Intermediate skills with Microsoft Excel (create, edit, sort, filter, pivot tables)
- Ability to work in the office 3-4 times a week
- Ability to work any of our 8-hour shift schedules during our normal business hours (8:00 am - 6:00 pm). It may be necessary, given the business need, to work occasional overtime
Nice To Haves
- 2+ years of experience with claims auditing and researching claims information
- Knowledge of Medicaid/Medicare/Commercial Reimbursement methodologies
Responsibilities
- Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization
- Investigate, recover, and resolve all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities
- Investigate and pursue recoveries and payables on subrogation claims and file management
- Initiate phone calls to other insurance companies to gather coordination of benefits information
- Process recovery on claims
- Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
- Use pertinent data and facts to identify and solve a range of problems within area of expertise
Benefits
- In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
