Recovery and Resolution Analyst – National Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

This position is full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 4:30pm, Monday – Friday. It may be necessary, given the business need, to work occasional overtime.

We offer 5 weeks of 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:

• Investigate, evaluate, and negotiate healthcare subrogation matters for a multi-million dollar portfolio up to $20M (70%)
  • Comprehend the nuances of Medicare, Medicaid, Self-Funded ERISA and Non-ERISA related health insurance subrogation recoveries and reimbursements to analyze and move cases to recovery for the clients, including the negotiation of dollars that will be returned to the plan
  • Research applicability of laws, regulations and other requirements to cases, contracts or decisions
  • Analyze data and interpret legal research to make conclusions.  Present results of analysis in writing and/or verbally to supports the Plan’s rights
  • Maintain working knowledge of ERISA and ensure adherence to state and federal subrogation laws
  • Utilize your understanding of and expertise of coverage, policy interpretation, contract interpretation, case law, state/federal regulations Identify, monitor and evaluate data to determine third party liability and reimbursement amounts; ongoing analysis of medical treatment to evaluate relatedness
• Conduct a high volume of outbound calls and send out or respond to electronic, written and verbal inquiries to/ from attorneys, insurance companies and health plan members (20%)
  • Communicate effectively with various parties using all forms of correspondence throughout the subrogation recovery process.  The analyst will correspond with plaintiff’s attorney, defense counsel, third party insurers, and all other parties of interest
  • Validate claim liability, adjuster’s contact information, claim status, availability of coverage, accident-related injuries and health plan members’ treatment status
• Thoroughly document all written and verbal communications and maintain case activity calendar diaries (10%)
• Ensure compliance with Health Insurance Portability and Accountability Act
• May be involved with litigation as necessary
• Must be able to act independent of an attorney, present the client’s case and negotiate a settlement with an adverse party with professionalism, integrity and vigor
• Recommend and participate in round table discussions of complex cases to determine the best strategic solutions
• Act as coach and mentor to other team members in the development of their subrogation technical skills
• Assist management on special projects and any other assigned tasks

 

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
• Must be 18 years of age OR Older
• 2+ years of healthcare claims experience
• Experience working in healthcare insurance
• Understanding of subrogation principles
• Ability to to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 4:30pm, Monday – Friday. It may be necessary, given the business need, to work occasional overtime

 

Preferred Qualifications:

• P&C (Property & Casualty) insurance experience
• Demonstrated negotiation experience, specifically in the capacity of persuading and influencing  others; ability to negotiate fair settlements consistent with the prevailing subrogation law
• Knowledge of local, state and federal laws and regulations pertaining to insurance
• Experience working with claims and/or recovery

 

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

 

Soft Skills:

• Candidate must be highly organized with effective and exceptional verbal and written communication skills
• Strong analytical, problem solving and decision-making skills required; ability to exercise good judgment
• Ability to prioritize work, handle multiple tasks and work independently
• Exceptional telephone and customer service skills; ability to interact professionally in challenging situations
• Open to change and new information; ability to adapt behavior and work methods to changing organization and integrate best practices into the subrogation recovery process

 

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

 

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C., Maryland Residents Only: The hourly range for this role is $23.22 to $45.43 per hour. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

 

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.

 

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.

 

#RPO