Reclamation Team Lead

This position follows a hybrid schedule with 3 – 4 in-office days per week. Our office is located at 100 Airpark Center East, Nashville, TN 37217.

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.

The Reclamation Team Lead will work with a team on researching issues to determine feasibility of reducing medical costs through prospective solutions of claim system processes and claim business rules.

This position is full-time (40 hours/week) 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 – 6:00 pm. It may be necessary, given the business need, to work occasional overtime.

We offer paid training. The hours during training will be 8:00 am – 6:00 pm, Monday – Friday.

   

Primary Responsibilities:

• Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization
• Investigate, recover, and resolve all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities
• Investigate and pursue recoveries and payables on subrogation claims and file management
• Initiate phone calls to other insurance companies to gather coordination of benefits information
• Process recovery on claims
• Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
• Use pertinent data and facts to identify and solve a range of problems within area of expertise

   

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 or older
• 1+ years of experience analyzing data and identifying cost saving opportunities OR relevant college courses including economics, statistics, data science, or finance
• Experience in healthcare industry
• Knowledge of medical claims Electronic Data Interchange (EDI) workflows including experience in identifying, researching, and resolving EDI claim errors and rejections
• Knowledge of claims processing systems and guidelines/processes
• Intermediate skills with Microsoft Excel (create, edit, sort, filter, pivot tables)
• Ability to work in the office 3-4 times a week
• Ability to work any of our 8-hour shift schedules during our normal business hours (8:00 am – 6:00 pm). It may be necessary, given the business need, to work occasional overtime

   

Preferred Qualifications:

• 2+ years of experience with claims auditing and researching claims information
• Knowledge of Medicaid/Medicare/Commercial Reimbursement methodologies

   

Telecommuting Requirements:

• Reside within commutable distance to the office at 100 Airpark Center East, Nashville, TN 37217.
• 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 $23.89 – $42.69 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

   

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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