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Healthcare Recovery Analyst – Eden Prairie, MN, Frederick, MD, or Wauwatosa, WI

UnitedHealth Group

Eden Prairie, MN
Job Code:
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Job Details

Healthcare Recovery Analyst – Eden Prairie, MN, Frederick, MD, or Wauwatosa, WI(Job Number:721983)

Position Description:

Energize your career with one of Healthcare’s fastest growing companies.  
You dream of a great career with a great company - where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.
This opportunity is with one of our most exciting business areas: Optum - a growing part of our family of companies that make UnitedHealth Group a Fortune 17 leader.
Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.
As a Healthcare Recovery Analyst, you will be responsible for recovering subrogation money. This position requires the skills to successfully investigate, evaluate, and handle to conclusion injury claims. These may include attorney-represented claims, complex injury claims, and litigated claims. As a Healthcare Recovery Analyst, you will be responsible for identifying claims containing healthcare subrogation opportunities and working with all involved parties to ensure thorough investigation and negotiation of settlements. You will be accountable for all stages of the process from initial contact to review of plan language and negotiation of the plan’s subrogation interest. This role is ultimately responsible to read and interpret case law, statutes, and regulations and to articulate legal arguments in order to negotiate settlements within authority level to maximize dollars recovered and achieve customers’ financial expectations. Individuals in this role will act as a subject matter with identifying, communicating, and recovering healthcare dollars as deemed appropriate.

Primary Responsibilities:
  • Investigates, evaluates, and negotiates healthcare subrogation matters with an annual recovery goal from $1M to $5M
  • 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
  • Ensure compliance with Health Insurance Portability and Accountability Act
  • Conduct a high volume of outbound calls and expeditiously send out or respond to electronic, written and verbal inquiries to / from attorneys, insurance companies and health plan members
  • Validate claim liability, adjuster's contact information, claim status, availability of coverage, accident-related injuries and health plan members' treatment status
  • 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
  • Thoroughly document all written and verbal communications and maintain
  • Successfully maintain multi-million-dollar portfolio up to $50M
  • 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
  • Assist with training and mentoring for other Subrogation staff as needed
  • Other tasks or projects as needed to support the Subrogation Team

Job Claim Recovery/Resol/COB/Subro
Primary Location US-MN-Eden Prairie
Other Location US-WI-Wauwatosa, US-MD-Frederick
Organization Optum Ops-Payment Integrity
Schedule Full-time
Number of Openings 7
Apply on the Company Site

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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