26 days old

Recovery and Resolutions Representative - San Antonio, Texas

San Antonio, TX 78205
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  • Job Code
    891000

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life's best work. (sm)

 

Persons in this function are responsible for investigating, recovering and resolving all types of overpaid claims for health plans, vendors and government entities. Process incoming refund checks through claims adjustment when needed coordinating with accounting as indicated, while ensuring adherence to state and federal compliance policies, reimbursement policies and contract compliance. May include initiating telephone calls to members, providers and other insurance companies to gather information including coordination of benefits data, including but not limited to investigation of medical history.  

 
Primary Responsibilities:
  • Investigate recovering and resolving all claims, recovery, resolution for health plans
  • Initiate telephone calls to members providers and other insurance companies to gather COB data
  • Applies knowledge / skills to complex activities using in-depth analytical research 
  • Investigate and pursue recoveries and payables on subrogation claims and file management.
  • Verify/ensure that overpayment/refund checks are properly applied to the appropriate claims/overpayment.
  • Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance.
  • May conduct contestable investigations to review medical history
  • May monitor large claims including transplant cases. Verify/ensure that overpayment/refund checks are properly applied to the appropriate claims/overpayment
  • Demonstrates a depth and breadth of knowledge/skills in own area and is often able to apply these outside of own function 
  • Often acts as a technical resource to others in own function 
  • Anticipates customer needs and proactively identifies solutions 
  • Solves complex problems on own; proactively identifies new solutions to problems 
  • Plans, prioritizes, organizes and completes work to meet established objectives 
  • Acts as a facilitator to foster relationships with vendors and resolve provider concerns
  • Seen as key team member on project teams spanning more than own function 
  • Work does not usually require established procedures. Requires independent workflow management
  • Manages Daily inventory
 
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
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Posted: 2020-09-25 Expires: 2020-10-25

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Recovery and Resolutions Representative - San Antonio, Texas

UnitedHealth Group
San Antonio, TX 78205

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