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Conditional Payment Verification Specialist - Tampa, FL

UnitedHealth Group

Tampa, FL
Job Code:
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Job Details

745350 Conditional Payment Verification Specialist Tampa FL

Conditional Payment Verification Specialist - Tampa, FL (745350)

Position Description

Position Description:

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.(sm)

Primary Responsibilities: 
  • Responsible for all conditional payment reporting and procurement of conditional payment letters from Medicare, Medicare Advantage Plans and Medicaid for workers’ compensation, auto and liability cases.
  • Serve as the liaison between Optum Settlement Solutions and BCRC / CRC / CMS / MAPs / Medicaid.
  • Performs follow up for final settlement documents and distributes to the lead contractor once received.
  • Works directly with legal staff for final demands or appeals process.
  • Processes all mail related to conditional payment letters received
  • Manages the required paperwork such as Letters of Authorization, Proof of Representation and Consent to Release forms
  • Work directly in the Medicare Secondary Payer Recovery portal (internet - based) and Optum’s Medicare Connect portal
  • Distributes the status responses that the BCRC / CRC generates.
  • Provides status updates to client regarding conditional payment issues.
  • Responsible for handling all phone calls, emails and faxes on assigned cases.
  • Participates on client conference calls and trains new associates within the conditional payment team, as needed.
  • Works with Management on special projects as necessary.
  • Performs other job functions as assigned by management.
Required Qualifications:
  • High School Diploma / GED or higher
  • 1+ years of complex Claims experience (i.e. Worker’s Compensation / Auto / Liability, Case Management, High Dollar Claims, Medicare Secondary Payor Services)
  • Experience with Microsoft Word (Ability to create and edit professional documents)
  • Experience with Microsoft Outlook (Ability to create and send emails and calendar invites)
  • Experience with Microsoft Excel (Ability to edit, filter, sort, analyze data and use formulas)
Preferred Qualifications:
  • Associate's Degree (or higher)
  • Medical, Adjuster background or prior Conditional Payment Verification experience
  • Previous Medicare Secondary Payer Recovery experience
  • Knowledge of / work experience utilizing ICD - 9 / ICD - 10 coding and medical terminology understanding
Soft Skills:
  • Ability to work in a fast paced environment
  • Ability to manage one's own time and work with a team
  • Must have strong organizational skills, detail oriented and focus on meeting deadlines
  • Strong written and verbal communication skills
Physical Requirements and Work Environment:
  • Extended periods of sitting at a computer and use of hands / fingers across keyboard or mouse
  • Office environment

This position requires ACHA Level II Background checks (fingerprinting) by the State of Florida for all Clinicians that have face-to-face contact with members and will require renewal every five years.

OptumRx is an empowering place for people with the flexibility to help create change. Innovation is part of the job description. And passion for improving the lives of our customers is a motivating factor in everything we do.


If you're ready to talk about groundbreaking interactions, let's talk about what happens when a firm that touches millions of lives decides to gather results from millions of prescriptions every month and analyze their impact. Let's talk about smart, motivated teams. Let's talk about more effective and affordable healthcare solutions. This is caring. This is great chemistry. This is the way to make a difference. We're doing all this, and more, through a greater dedication to our shared values of integrity, compassion, relationships, innovation and performance.  Join us and start doing your life’s best work.SM

Diversity creates a healthier atmosphere: United Health 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.

United Health Group
is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: Optum, OptumRx, conditional payment, medicare, medicaid, claims, worker’s compensation, case management

Job Details

  • Contest Number745350
  • Job TitleConditional Payment Verification Specialist - Tampa, FL
  • Job FamilyClaims
  • Business SegmentOptumRx

Job Location Information

  • Tampa, FL
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusNon-exempt

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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