Claims Investigation Recovery and Resolution Auditor and Trainer – National Remote

UnitedHealth Group is a health care and well-being company that’s dedicated to improving the health outcomes of millions around the world. We are comprised of two distinct and complementary businesses, UnitedHealthcare and Optum, working to build a better health system for all. Here, your contributions matter as they will help transform health care for years to come. Make an impact with a diverse team that shares your passion for helping others. Join us to start Caring. Connecting. Growing together.

As a Claims Investigation Recovery & Resolution Auditor and Trainer you will be investigating, recovering, and resolving all types of claims for health plans, commercial customer and govt entities. In this role you will be initiating telephone calls to members, providers, and other insurance companies to gather coordination of benefits data. You will also investigate and pursue recoveries and payables on subrogation claims and file management, process recovery on claims. Working as a Trainer for the team, you will be responsible for all aspects of training for Claims Investigation Recovery & Resolution staff working alongside the team lead and Supervisor to provide ongoing coaching/ guidance to the team. The Trainer focuses on teaching all related areas of Claims Investigation and Recovery (Subrogation, Recovery, and Coordination of Benefits). They also be responsible for the development of comprehensive training programs for new hire and ongoing training for existing staff. This includes, but isn’t limited to conducting training sessions, workshops, refresher trainings, developing training materials, manuals, guides, and online resources. These trainers also audit, assist, provide feedback, and provide coaching to Claims Investigation Recovery & Resolution Representatives going through training. In this role, you will be using Macess, Facets, Microsoft Teams, and Microsoft Outlook on a daily basis. You would have a team lead, supervisor and manager to lean on for any questions. You would attend weekly team meetings.

This position is full time, Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am – 5:00 pm PST. It may be necessary, given the business need, to work occasional overtime.

We offer weeks of paid on-the-job training. The hours of the training will be aligned with your schedule.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

 

Primary Responsibilities:

• Provide expertise claims support by reviewing, researching, investigating, negotiating and resolving all types of claims as well as recovery and resolution for health plans, commercial customers and government entities
• Analyze and identify trends and provides reports as necessary
• Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance
• Solves moderately complex problems on own
• Plans, Prioritizes, organizes and completes work to meet established objectives
• May coordinate work of other team members
• Proactively identifies solutions to non-standard requests
• Sometimes acts as a technical resource to others in own function

 

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.

Required Qualifications:

• High School Diploma / GED OR equivalent work experience
• Must be 18 years of age OR older
• 8+ years training experience
• 8+ years auditing experience
• 5+ years of FACETS/ Macess experience
• 5+ years of insurance experience
• Moderate proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
• Microsoft Office including Microsoft Word (create correspondence and work within templates), Microsoft Excel (ability to sort, filter, and create simple spreadsheets), Microsoft Outlook (Create emails and send emails)
• Ability to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm PST.

Preferred Qualifications:

• Experience with Recovery & Subrogation claims, 3rd party liability, and/ or Coordination of Benefits.

Telecommuting Requirements:

• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

 

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy  

 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $23.41 – $41.83 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

 

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

 

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

 

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