Senior Recovery / Resolution Representative - Eden Prairie, MN Or US Telecommute

Unitedhealth Group Inc. Eden Prairie , MN 55344

Posted 4 months ago

Energize your career with one of Healthcare's fastest growing companies.

You dream of a great career with a great company where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it's a dream that definitely can come true. Already one of the world's leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.

This opportunity is with one of our most exciting business areas: Optum a growing part of our family of companies that make UnitedHealth Group a Fortune 5 leader.

Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.

Do you have experience investigating healthcare claims? Are you a hotshot Microsoft Excel user? Want to work with an elite team of some of the brightest and most inventive people in the healthcare & technology industries? Optum is a health services business, part of the UnitedHealth Group family of companies, dedicated to making the health system work better for everyone. We serve people throughout the entire health system. Our team enjoys conversation - changing, life - changing, world - changing opportunities throughout their careers. Join us and see what it's like to do your life's best work.

Senior Recovery / Resolution Representative will be responsible for receiving and reviewing cases to determine if medical records need to be requested for further review. They will also be responsible for creating and preparing medical records requests and conducting provider follow ups to receive the records. This position supports identification of suspected waste & abuse of health insurance claims. This position will be based at our Eden Prairie, MN location.

Primary Responsibilities:

  • Analyze large spreadsheet of data

  • Determine appropriate list of claims / patients that require medical records for review

  • Create medical records request letters

  • Receive and document medical records within case tracking system

  • Additional follow - up with Providers to obtain all records requested

  • Prepare case to move to Investigations / Escalations teams

  • Ensure adherence to federal compliance policies, contract compliance

  • Collaboration with Clinical Investigator, Legal and Compliance for case review

Required Qualifications:

  • High School Diploma / GED (or higher)

  • 1 years of experience working in a fast - paced, high volume production / metric - based environment

  • 1 years of healthcare experience

  • Proficient use of multiple screens, systems and platforms simultaneously

  • 1 years of work experience using Microsoft Excel (sorting, filtering, data input, editing and creating spreadsheets)

  • 1 years of work experience using Microsoft Word (editing & creating documents)

Preferred Qualifications:

  • 2 years of health insurance claims experience

  • Medicare / Medicaid program knowledge

  • Experience with Fraud, Waste, Abuse, & Error or Payment Integrity

  • Knowledge of the following Claims platforms: COSMOS; CPW; CSP; Diamond; Facets; Oxford; NICE

  • 1 years of work experience using Microsoft Excel (pivot table experience)

Soft Skills:

  • Strong written, verbal, analytical, organizational, time management and problem solving skills

  • Ability to adapt in a dynamic and high - growth environment

  • Ability to work independently

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.SM

Diversity creates a healthier atmosphere: 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.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: audit, records, research, resolution, documentation, cases, claims, healthcare, insurance, high - volume, metrics, excel, msword, medicare, Medicaid, platforms expression, marital status, genetic information, or any other characteristic protected by law.


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Senior Recovery / Resolution Representative - Eden Prairie, MN Or US Telecommute

Unitedhealth Group Inc.