The health care system is still evolving at a rapid pace. Technology is driving new advances in how patient care is delivered and how it's reimbursed. Now, UnitedHealth Group invites you to help us build a more accurate and precise approach to claims adjudication. As part of our Recovery and Resolutions team, you'll help understand and overcome errors in claims processing. You'll have all the tools and backing you need to help manage subrogation files, negotiate settlements and ensure adherence to compliance policies. All the while, you'll be building your career with a leader and reaching for the highest levels of performance as you do your life's best work.(sm)
- Investigation, recovery and resolution of all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities
- Initiate phone calls to members, providers and other insurance companies to gather coordination of benefits
- Investigate and pursue recoveries and payables on subrogation claims and file management
- Process recovery on claims
- Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance
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.
- High school diploma or GED or equivalent work experience
- 1+ years of experience analyzing and solving customer problems
- 2+ years of healthcare claims examiner or claims recovery experience
- Intermediate level of Microsoft Excel
- EZCAP experience
- Experience with recoveries and payables on Subrogation Claims
- Experience using claims platforms such as UNET, Pulse, NICE, Facets, Diamond, etc
What's the first thing that happens when one of the most successful physician groups in Orange County comes together with a global leader in health care? Opportunity. With Monarch HealthCare joining OptumCare and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. With a vibrant network of hospitals and urgent care centers, we're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do your life's best work. SM
Monarch HealthCare® , is led by doctors who are committed to offering patients the most extensive choices and access to Orange County's leading physicians, hospitals, labs and urgent care centers. This allows patients to get the perfect care in support of their good health. Monarch HealthCare's independent, private-practice physicians are part of a coordinated network that works together to promote excellence in patient care.
Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: Recovery, Resolutions Analyst, Irvine, CA, California, Healthcare, health care, Managed Care, Claims, Customer Service, Claims Recovery