Senior Recovery Resolution Representative

Claims Adjudication Specialist

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, United Health 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.

This position is full-time, Monday - Friday. Employees are required to have flexibility to work during our normal business hours of 8:00 AM - 5:00 PM. It may be necessary, given the business need, to work occasional overtime.

We offer 4 weeks of on-the-job training. The hours of training will be aligned with your schedule.

Primary 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.

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.

Required Qualifications:

• 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.

Preferred Qualifications:

• Experience using EDSS, Doc
  360, 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

Telecommuting Requirements:

• 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 United Health Group approved high-speed internet connection or leverage an existing high-speed internet service

Soft Skills:

• 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

Pay is based on…