Healthcare Claims Representative

UnitedHealth Group; Makati; On-site; PHP 350,000 - 550,000; Full time

Job summary

UnitedHealth Group's Optum team is seeking a claims recovery specialist to review, research, negotiate and resolve claims for health plans, commercial clients and government entities. You will help ensure policy adherence and accurate processing while supporting recovery efforts.

You will also analyze trends, generate reports, and manage multiple products and benefits with a focus on quality and efficiency in a fast-paced environment.

Qualifications

• College graduate of any 4 year course.
• 4+ years of experience in claims recovery and resolution.
• Proficiency with computer and Windows PC applications.
• Proven ability to multi-task

Responsibilities

• Provide expertise claims 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 and identify trends and provides reports as necessary
• Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance
• 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

Skills

Multi-tasking

Analytical skills

Claims experience

Communication

Education

College graduate of any 4 year course

Tools

Windows PC applications

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Primary Responsibilities:

• Provide expertise claims 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 and identify trends and provides reports as necessary
• Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance
• 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:

• College graduate of any 4 year course
• 4+ years of experience in claims recovery and resolution
• Proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
• Proven ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product

Physical Requirements and Work Environment:

• Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouse

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.

Optum is a drug-free workplace. © 2026 Optum Global Solutions (Philippines) Inc. All rights reserved.