Healthcare Investigation Representative

Optum Philippines; Makati; Sur place; PHP 300 000 - 420 000; Plein temps

Résumé du poste

Optum Philippines is seeking a detail‑oriented professional to provide claims expertise support across health plans and government entities. You will review, investigate, negotiate and resolve diverse claims while ensuring compliance with policies and regulatory requirements.

The role involves analyzing trends, generating reports, and managing subrogation files within a fast-paced environment. A 4‑year college degree and 1+ year of claims experience are required, with opportunities for growth

Qualifications

• College graduate of any 4 year course.
• 1+ years of claims or collections experience.
• 1+ year of experience analyzing and solving customer problems.

Responsabilités

• 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.
• Adhere to employment contracts and company policies, including flexible work arrangements and policy changes.

Connaissances

Claims experience

Customer problem solving

Reporting

Formation

Bachelor's degree (4-year)

Description du poste

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 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.
• 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 of any 4 year course.
• 1+ years of claims or collections experience.
• 1+ year of experience analyzing and solving customer problems.

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.

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