Healthcare Investigation Representative

Optum, a UnitedHealth Group Company; Makati; Presencial; PHP 300.000 - 540.000; Jornada completa

Descripción de la vacante

Optum, a UnitedHealth Group company, is seeking a qualified Claims Specialist to join our Philippines team. You will review and resolve claims for health plans and government entities, research issues, and ensure compliance with policies while supporting recovery and subrogation efforts.

This role requires a college graduate with 1+ year in claims or collections, plus strong problem-solving and analytical skills to identify trends and deliver accurate resolutions in a fast-paced environment.

Formación

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

Responsabilidades

• Provide claims expertise support by reviewing, researching, investigating, negotiating and resolving all types of claims.
• Analyze, identify trends and provide reports as necessary.
• Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance.
• Manage subrogation files.

Conocimientos

Claims processing

Customer service

Analytical thinking

Educación

Bachelor's degree

Descripción del empleo

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.