Claims Resolution Specialist

2 weeks ago


Makati City, National Capital Region, Philippines UnitedHealth Group Full time

Optum, a global organization, delivers care through technology to improve health outcomes. The work with our team enhances health by connecting people with necessary resources.

The role of a Healthcare Claims Representative involves resolving claims for health plans and commercial customers. This requires expertise in reviewing, researching, investigating, negotiating, and resolving various types of claims.

Key Responsibilities:

  • Provide claims support by analyzing and identifying trends, ensuring adherence to state and federal compliance policies, and contract compliance.
  • Analyze data to identify patterns and provide reports as necessary.
  • Ensure that all claims are processed in accordance with established policies and procedures.

Required Qualifications:

  • A high school diploma or equivalent, or 10+ years of equivalent working experience.
  • 4+ years of experience in claims recovery and resolution.
  • Moderate proficiency with computer applications, including the ability to learn new complex systems.
  • Proven ability to multitask, understand multiple products, and levels of benefits within each product.

At UnitedHealth Group, our mission is to help people live healthier lives. We believe everyone deserves equal access to healthcare. Our commitment to mitigating our impact on the environment and enabling equitable care addresses health disparities and improves outcomes.



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