Healthcare Claims Specialist — Recovery & Resolution

UnitedHealth Group; Philippines; On-site; Confidential; 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

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.