Senior Recovery and Resolution Analyst

UnitedHealth Group•Tampa, FL

7h•$29 - $52•Remote

About The Position

This position is National Remote. You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. 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 Senior Recovery / Resolution Analyst 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 - 5:00 pm. It may be necessary, given the business need, to work occasional overtime. This will be paid on-the-job training. The hours during training will be 8:00 am - 5:00 pm, Monday - Friday.

Requirements

High school Diploma / GED OR equivalent work experience
Must be 18 years of age OR older
2+ years of experience with claims auditing and researching claims information
1+ years of experience analyzing data and identify cost saving opportunities
Experience working with medical claims platforms
Experience in healthcare
Experience with Payment Integrity
Knowledge of claims processing systems and guidelines/processes
Intermediate skills with Microsoft Excel (create, edit, sort, filter, pivot tables)
Ability to work 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 - 5:00 pm. It may be necessary, given the business need, to work occasional overtime

Nice To Haves

1+ years of project management experience
Knowledge of Medicaid/Medicare Reimbursement methodologies
Microsoft Access (create, edit, format, manipulate data)

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 medical claims
Initiate phone calls to members, providers, and other insurance companies
Process payment 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