recovery, resolutions representative - Taguig city, ncrUnitedHealth Group

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)
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, UnitedHealth Group invites you to help us build a more accurate and precise approach to claims adjudication. As part of our Recovery and Resolutions team, you'll help understand and overcome errors in claims processing. You'll have all the tools and backing you need to help manage subrogation files, negotiate settlements and ensure adherence to compliance policies.
Primary Responsibilities:
Provide claims expertise 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, identify trends and provide reports as necessary
Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance
Manage subrogation files
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
This is a challenging role with serious impact. You'll need to sort through complex situations to understand and clarify where errors happened or where they may continue to happen. It's a fast paced environment that takes focus, intensity and resilience.
Required Qualifications:
College graduate of any course
Minimum of 5 years working experience, at least 3 years of which is experience in Claims Investigation (preferably in Healthcare, other industries accepted)
Experience with one or more of the following:
Claims processing
Provider demographic information
Insurance billing practices
Experience using claims platforms such as UNET, Pulse, NICE, Facets, Diamond, etc.
Moderate work experience within own function
Intermediate to advanced experience with Microsoft Office - Microsoft Excel (sort and filter data) and Microsoft Word (create and edit documents)
Preferred Qualifications:
Preferably with working internet connection of at least 15 mbps in case of working from home. The following options are also available:
Corporate internet subsidy for those within available and valid serviceable locations, subject to Company Policy
Onsite work for those who are amenable to drive or commute to our office locations
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: Senior Recovery, Resolutions Representative, Claims, Healthcare, UNET, Pulse, NICE, Facets, Diamond, Taguig City, NCR, National Capital Region
UnitedHealth Group

Taguig City, Metro Manila
Permanent
Full-time