Healthcare Investigation Representative

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.

Primary Responsibilities:

1. 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.
2. Analyze, identify trends and provide reports as necessary.
3. Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance.
4. Manage subrogation files.
5. 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).

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:

1. College graduate.
2. 3+ years of claims or collections experience.
3. 3+ years of experience analyzing and solving customer problems.

Preferred Qualifications:

1. Experience working with subrogation.
2. Experience with negotiations.
3. 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.