UnitedHealth Group is among the most ambitious Fortune 25 companies you'll ever meet. Through our family of businesses, we're working to make the health care system perform better for more people, in more ways than ever.
Simply put, we think the entire system can be greater than it's ever been. And that drives us to work harder, aim higher, and expect more from one another.
Here, you'll be empowered to make an immediate impact for millions of others. And you'll achieve more than you ever expected. How does that fit with your plans?
Recovery/Resolution Analyst - Eden Prairie, MN-315449
UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.
Description Ingenix is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
If you get excited about the life transforming potential of bringing health care information to the right place, at the right time, to support crucial decisions, welcome to Ingenix.
We're one of the largest and fastest growing health information companies and the only organization in our industry with the information, technology and consulting expertise to solve the most significant challenges in health and human services.
As a vital member of the UnitedHealth Group family, we serve customers in every segment of the health care field. This includes government agencies, pharmaceutical companies, hospitals and health delivery networks, insurance providers and, of course, the diverse business divisions of UnitedHealth Group.
Position Description:
Positions in this function are responsible for investigating, recovering and resolving all types of claims as well as recovery and resolution for health plans, commercial customers and government entities. May include initiating telephone calls to members, providers and other insurance companies to gather information on suspect fraud and abuse. Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance. May conduct contestable investigations to review medical history. A Recovery Resolution Analyst is responsible for analyzing and investigating claims. Provides explanations and interpretations within area of expertise. Review suspect claim submissions to identify suspect or aberrant billing patterns. Conduct provider license checks utilizing various investigative sources. Communicate and identify new aberrant claim activity to other related departments. Conduct member/provider telephonic interviews. Refer suspect providers for reporting, to the Department of Insurance or appropriate Medical Board. Collaborate with clinical, and/or legal on case strategies. Identify new suspect providers. Identify opportunities to inactivate, or modify current flags, or edits. Assess Reports to be presented to Customers that identify additional providers to review. Liaison with customer for case specific inquiries.
Bring your talent to an industry leader with the information, technology, and consulting expertise to help transform health and human services. No matter what your role, you'll be empowered to ask more questions, develop better solutions and help make the health care system greater than ever. Qualifications Qualifications:
- Uses pertinent data and facts to identify and solve a range of problems within area of expertise
- Investigates non-standard requests and problems, with some assistance from others
- Works exclusively within a specific knowledge area
- Prioritizes and organizes own work to meet deadlines
- Provides explanations and information to others on topics within area of expertise
- Undergraduate degree or equivalent experience
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. |
