recovery/claims Analyst (team1/2) - taguig city, ncrOptum

Energize your career with one of Healthcare's fastest growing companies.
You dream of a great career with a great company - where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it's a dream that definitely can come true. Already one of the world's leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.
This opportunity is with one of our most exciting business areas: Optum - a growing part of our family of companies that make UnitedHealth Group a Fortune 7 leader.
Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.
As a Healthcare Recovery Analyst, you will be responsible for recovering subrogation money. This position requires the skills to successfully investigate, evaluate, and handle to conclusion injury claims. These may include attorney - represented claims, complex injury claims, and litigated claims. As a Healthcare Recovery Analyst, you will be responsible for identifying claims containing healthcare subrogation opportunities and working with all involved parties to ensure thorough investigation and negotiation of settlements. You will be accountable for all stages of the process from initial contact to review of plan language and negotiation of the plan's subrogation interest. This role is ultimately responsible to read and interpret case law, statutes, and regulations and to articulate legal arguments in order to negotiate settlements within authority level to maximize dollars recovered and achieve customers' financial expectations. Individuals in this role will act as a subject matter with identifying, communicating, and recovering healthcare dollars as deemed appropriate.
Primary Responsibilities:
Investigates, evaluates, and negotiates healthcare subrogation matters with an annual recovery goal from $1M to $5M
Comprehend the nuances of Medicare, Medicaid, Self - Funded ERISA and Non - ERISA related health insurance subrogation recoveries and reimbursements to analyze and move cases to recovery for the clients, including the negotiation of dollars that will be returned to the plan
Research applicability of laws, regulations and other requirements to cases, contracts or decisions
Analyze data and interpret legal research to make conclusions.
Present results of analysis in writing and / or verbally to supports the Plan's rights
Maintain working knowledge of ERISA and ensure adherence to state and federal subrogation laws
Utilize your understanding of and expertise of coverage, policy interpretation, contract interpretation, case law, state / federal regulations Identify, monitor and evaluate data to determine third party liability and reimbursement amounts; ongoing analysis of medical treatment to evaluate relatedness
Ensure compliance with Health Insurance Portability and Accountability Act
Conduct a high volume of outbound calls and expeditiously send out or respond to electronic, written and verbal inquiries to / from attorneys, insurance companies and health plan members
Validate claim liability, adjuster's contact information, claim status, availability of coverage, accident - related injuries and health plan members' treatment status
Communicate effectively with various parties using all forms of correspondence throughout the subrogation recovery process. \The analyst will correspond with plaintiff's attorney, defense counsel, third party insurers, and all other parties of interest
Thoroughly document all written and verbal communications and maintain
Successfully maintain multi - million - dollar portfolio up to $50
Must be able to act independent loan attorney, present the client's case and negotiate a settlement with an adverse party with professionalism, integrity and vigor
Assist with training and mentoring for other Subrogation staff as needed
Other tasks or projects as needed to support the Subrogation Team
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:
Graduate of any business course
Experience in any BPO industry handled Subrogation or;
Experience in local insurance companies handled Subrogation
Ability to use Microsoft Excel to analyze data, formatting, and creating charts / tables
Ability to use Microsoft Word to generate professional correspondence
Ability to use Microsoft Outlook to manage multiple email boxes and calendars
Soft Skills:
Candidate need to be highly organized with effective and exceptional communication skills
Strong analytical, problem solving and decision - making skills; ability to exercise good judgment
Ability to prioritize work, handle multiple tasks and work independently
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
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. © 2020 Optum Global Solutions (Philippines) Inc. All rights reserved.
Keywords: Recovery/Claims Analyst, Subrogation, legal, paralegal, attorneys, investigation, claims, insurance, healthcare, United Healthcare, Taguig City, National Capital Region
Bossjob

Taguig City, Metro Manila
Permanent
Full-time