Senior Recovery Resolutions Analyst - Taguig City, NCR

Senior Recovery Resolutions Analyst - Taguig City, NCR

UnitedHealth Group
4-7 years
Not Specified

Job 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.(sm)
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.
Primary 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 members, providers, and 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
  • 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

Required Qualifications:
  • Any 4-year course
  • 5 years of claim processing and claim research experience
  • 3 years of Supervisory or Managerial experience
  • 1+ year of experience analyzing data and identify cost saving opportunities
  • Experience working with medical claims platforms
  • Experience in healthcare
  • Knowledge of claims processing systems and guidelines / processes
  • Intermediate skills with Excel

Preferred Qualifications:
  • Knowledge of Medicaid/Medicare Reimbursement methodologies
  • MS Access

Physical Requirements and Work Environment:
  • Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, long periods working at a computer
  • Service center environment with moderate noise level due to Representatives talking, computers, printers, and floor activity

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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