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:
Education level of at least a high school diploma or GED OR 10 years of equivalent working experience
4 plus years of experience in claims recovery and resolution
Moderate proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
Ability to multitask, this includes ability to understand multiple products and multiple levels of benefits within each product
Physical Requirement and Work Environment:
Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouse
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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/Affirmative Action 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.
Job Keywords: Healthcare Claims Representative, Claims Representative, Claims recovery, Claims resolution, Claims, OPI, Taguig City, NCR, National Capital Region
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