Senior Recovery Resolution Representative

UnitedHealth Group•Tampa, FL

2d•$20 - $36•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 health care system is still evolving at a rapid pace. Technology is driving new advances in how patient care is delivered and how it's reimbursed. Now, UnitedHealth Group invites you to help us build a more accurate and precise approach to claims adjudication. As part of the Recovery and Resolutions team, you will identify, investigate, and resolve claim payment inaccuracies while ensuring compliance with applicable policies and regulations. This role requires strong analytical skills, attention to detail, and the ability to navigate multiple systems to support recovery and resolution efforts. All the while, you'll be building your career with a leader and reaching for the highest levels of performance as you do your life's best work.

Requirements

High School Diploma / GED OR equivalent work experience
Must be 18 years of age OR older
2+ years of experience researching, processing, auditing, OR resolving healthcare claims
Experience interpreting claim details, payment history, contractual language, and benefit information
Ability to navigate multiple systems and applications to conduct claim research and analysis
Ability to work full-time, Monday through Friday, with flexibility during normal business hours of 8:00 AM to 5:00 PM and occasional overtime as needed.
Ability to keep all company sensitive documents secure (if applicable)
Required to have a dedicated work area established that is separated from other living areas and provides information privacy
Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
Strong analytical and critical thinking skills
Excellent written and verbal communication skills
Ability to prioritize workload and manage competing priorities
Demonstrated attention to detail and accuracy
Ability to work independently and collaboratively in a fast-paced environment
Ability to make sound decisions based on claim details, policies, and supporting documentation

Nice To Haves

Experience using EDSS, Doc360, PICTS, CAP, or similar claim research and workflow management applications
Experience using healthcare claims processing and research platforms such as FACETS, COSMOS, UNET, NICE, or similar systems
Ability to navigate multiple systems, interpret claim history, conduct research across various platforms, and quickly learn new applications

Responsibilities

Provide claims expertise by reviewing, researching, investigating, and resolving healthcare claims and recovery opportunities for health plans, commercial customers, and government entities.
Analyze claim outcomes, identify trends, and communicate findings to support process improvement opportunities.
Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance
Meet productivity, quality, and compliance standards while managing assigned inventory.
Utilize multiple internal systems and applications to research claim history, validate findings, and document resolution activities.
This role requires strong analytical skills, attention to detail, and the ability to research complex claim scenarios while maintaining quality and productivity standards.