Recovery / Resolutions Analyst - Eden Prairie, MN or US Telecommute

UHG Eden Prairie, MN

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

The Recovery / Resolution Analyst handles information about patient services and how the services are paid by investigating and pursuing recoveries through contact with various parties.
Primary Responsibilities:
  • Perform investigation on tips / allegations to identify potential Fraud, Waste, Abuse, or Error (i.e. internet research, review claims history on various platforms and FWAE databases), based on applicable Job Aids
  • Perform member and provider interviews, and review medical documentation as needed
  • Document in a professional manner the investigation activities that were performed on tips and allegations
  • Adjust claims as needed based on investigation performed
  • Refer tip / allegation to the appropriate internal team
  • Communicate with clients and business partners as needed
  • Submit CMS reporting as required
  • Ensure adherence to state and federal compliance policies and reimbursement policies
  • Adhere to turn around time standards
  • Meet and maintain minimum quality and productivity

Required Qualifications:
  • High School Diploma / GED (or higher)
  • 1+ years of insurance or fraud investigation experience
  • 2+ years of Insurance experience with one or more of the following: Claim Processing, Provider Demographic Information or Insurance Billing Practices
  • Proficiency within Microsoft Excel (ability to create pivot tables, and use spreadsheet for tracking)
  • Must be available to work 7:00am - 3:30pm, Monday - Friday
Preferred Qualifications:
  • 2+ years of experience in criminal justice, legal or fraud investigation
  • Experience in working with claims platforms
  • Professional Certification as a Certified Fraud Examiner (CFE), Accredited Healthcare Fraud Investigator (AHFI), or similar
  • Familiar with CPT code terminology
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.

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: recovery/resolutions analyst, claims platforms, claims processing, insurance billing practices, Eden Prairie, MN