Recovery ReSols Analyst - Taguig City, NCR

Recovery ReSols Analyst - Taguig City, NCR

UnitedHealth Group
4-7 years
Not Specified

Job Description



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 our Recovery and Resolutions team, you'll help understand and overcome errors in claims processing. You'll have all the tools and backing you need to help manage subrogation files, negotiate settlements and ensure adherence to compliance policies. 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.(sm)
Primary Responsibilities:
  • Investigation, recovery and resolution of 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
  • Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

This is a challenging role with serious impact. You'll need to sort through complex situations to understand and clarify where errors happened or where they may continue to happen. It's a fast-paced environment that takes focus, intensity and resilience.
Required Qualifications:
  • Graduate of any 4-year course
  • 1+ years of Team Leader / Supervisory experience
  • 5 years of claims processing and claims research experience
  • Claims Research and investigations experience
  • Experience using claims platforms such as UNET, Pulse, NICE, Facets, Diamond, etc.

Preferred Qualification:
  • Fraud and Abuse Process experience

Job Details

Careers with Optum. Here's the idea. We built an entire organization around one giant objective make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm) Diversity creates a healthier atmosphere: Optum is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law. Optum is a drug-free workplace. © 2021 Optum Global Solutions (Philippines) Inc. All rights reserved.

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