Healthcare claims representative, makati cityUnitedHealth Group

Job Description
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
Positions in this function are responsible for investigating, recovering and resolving all types of claims as well as recovery and resolution for health plans, commercial customers and government entities. May include initiating telephone calls to members, providers and other insurance companies to gather coordination of benefits data. 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. May conduct contestable investigations to review medical history. May monitor large claims including transplant cases.
Primary Responsibilities:
Provide expertise claims support by reviewing, researching, investigating, negotiating and resolving all types of claims as well as recovery and resolution for health plans, commercial customers and government entities
Analyze and identify trends and provides reports as necessary
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
Required Qualifications:
An education level of at least a high school diploma or GED OR 10 years of equivalent working experience
4+ years of experience in claims recovery and resolution
Extensive work experience within own function
Moderate proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product
Physical Requirements and Work Environment:
Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouse