Senior Recovery / Resolutions Representative - Frederick, MD

UHG Frederick, MD

About the Job

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

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 6 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, and Performance.

The Senior Recovery / Resolutions Representative is responsible for performing investigative work to validate insurance coverage with other carriers for UnitedHealthcare (UHC) members that have multiple health insurance coverages to ensure claims are processed correctly by the payer with primary payment responsibility. The Senior Recovery / Resolutions Representative will update the applicable UHC systems that impact claim payment. The investigative process may include initiating telephone calls to members, providers and other insurance companies to gather coordination of benefits data.

Primary Responsibilities:

  • Initiate contact with members, providers, and other insurance companies to obtain and document coordination of benefits information.
  • Leverage a questions - based approach to obtain information and exercise reflective listening skills to identify underlying, root cause issues.
  • Prioritize assigned tasks with minimal guidance from SMEs and management.
  • Coordinate directly with other team members to balance workload, execute priorities, and ensure assigned goals and objectives are met or exceeded.
  • Identify and resolve problems using defined processes, expertise, and judgment.
  • Communicate areas of potential improvement to SMEs for potential incorporation into processes to increase productivity, quality, and / or customer satisfaction.
  • Analyze and interpret data.  Present the results of data analysis to SMEs and management, as appropriate, in a concise and crisp manner.
  • Leverage problem - solving skills within established guidelines to resolve issues, questions, and conflict at the lowest level possible within the organization.
  • Ability to work independently and as a team with limited supervision.
  • Possess strong attention to detail with the ability to think in a logical and structured manner to identify problems and present solutions for consideration.
  • Ability to multi - task including the ability to understand multiple products and multiple levels of benefits within each product.
  • Leverage strong communication skills (verbal, non - verbal, and written) with a demonstrated ability to communicate ideas clearly and concisely with peers, superiors, members, and providers. 
  • Provide claims support by reviewing, researching, investigating and resolving all types of claims as well as resolution for health plans, commercial customers, and government entities
  • Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
  • Perform other duties as assigned
  • Develops and expands knowledge of COB Rules, basic computer skills and business etiquette
  • Performs basic and specialty workflow and administrative tasks with minimal supervision
  • Collaborate with others to identify and solve moderate problems that promote efficiency and quality
  • Initiate telephone calls to members, providers and other insurance companies to gather COB data
  • Receive and respond to incoming telephone inquiries
  • Determine primacy using published COB guidelines
  • Update eligibility system / database with outcome of primacy investigation
  • Document and communicate outcome of investigation following departmental procedures
  • Meet productivity, quality and timeliness goals
  • Respond to routine or standard requests to meet customer needs
  • Focus on Customers, exceed expectations and improve customer experience
  • Make fact - based decisions, use sound judgment and apply business knowledge
  • Act ethically, demonstrate integrity, comply with all laws, regulations and policies

Required Qualifications:

  • High school diploma / GED or higher
  • 3+ years of experience in the healthcare industry.
  • 2+ years of experience with the Microsoft Office Suite (Word, PowerPoint, Excel, and Outlook).
  • 2+ years experience analyzing and solving customer problems in an office, claims, or customer service environment.
  • 1+ years of Claims or Call Center experience
  • 1+ years of Customer Service experience analyzing and solving customer problem
  • 2+ years of experience with computer and Windows PC applications, including basic knowledge of Microsoft Excel (formulas and navigation), Microsoft Word (creating documents and navigation), and Microsoft Outlook (creating and opening emails

Preferred Qualifications:

  • Experience within coordination of benefits.

Physical Requirements and Work Environment:

  • Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, long periods working at a computer
  • Service center environment with moderate noise level due to Representatives talking, computers, printers, and floor activity
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: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer 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.

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


Keywords: Customer service representative, customer service, CSR, UnitedHealth Group, call center, health care, healthcare, office, phone support, training class, Optum, OptumRx, mail room, warehouse, shipping, receiving