Healthcare Investigation Representative

Job title: Healthcare Investigation Representative

Company: UnitedHealth 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. Work does not usually require established procedures.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
• Works independently
• Mentors others
• Acts as a resource for others
• Coordinates others’ activities
• 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
• 3+ years of claims or collections experience
• 3+ year of experience analyzing and solving customer problems
• Extensive work experience, possibly in multiple functions

Preferred Qualifications:

• Experience working with subrogation
• Experience with negotiations
• Experience working in the health care industry

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.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. © 2024 Optum Global Solutions (Philippines) Inc. All rights reserved.

Expected salary:

Location: Makati City, Metro Manila

Job date: Thu, 23 Jan 2025 23:38:10 GMT

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