Recovery Resolution Representative

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.  

Performs routine and specialty COB investigations, determines primacy of other coverage for members who have two or more health policies in order to avoid overpayment payment of claims, populates data into eligibility systems, appropriately communicates results and develops subject matter expertise in one or more workflows or eligibility systems

Primary Responsibilities:

• Develops and expands knowledge of COB Rules, basic Computer skills and business etiquette
• Performs basic and specialty workflow and administrative tasks with minimal supervision
• Collaborates with others to identify and solve moderate problems and create procedures that promote efficiency and quality
• Initiates telephone calls to members, providers and other insurance companies to gather COB data
• Receives and respond to incoming telephone inquiries
• Determines primacy using published COB
• Updates eligibility system/ database with outcome of primacy investigation
• Documents and communicates outcome of investigation following departmental procedures
• Meets productivity, quality and timeliness goals
• Responds to routine or standard requests to meet customer needs
• Focuses on Customer; exceeds expectations and improves customer experience
• Makes fact- based decisions; uses sound judgment and applies business knowledge
• Acts ethically; demonstrates integrity, complies with all laws, regulations and policies
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

• 2+ years work experience
• Good computer skills and intermediate proficiency working in a windows environment
• Proven excellent written and verbal communications skills
• Proven solid Customer Service skills
• Proven solid analytical and communication skills
• Proven to be a team player; works effectively with others
• Proven to be self-directed and highly motivated
• Proven high level of personal and professional ethics
• Proven ability to work in a production environment
• Proven ability to meet/exceed productivity, quality and timeliness goals
• Proven ability to work independently and exercise sound judgment

Preferred Qualifications:

• Bachelor's Degree or equivalent experience
• 1+ years of US Healthcare and/or COB experience
• Intermediate proficiency in Microsoft applications (Power Point, Excel, Outlook, Word)

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.