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Senior Recovery Resolution Representative - San Antonio, TX

UnitedHealth Group

San Antonio, TX
Job Code:
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Job Details

Senior Recovery Resolution Representative - San Antonio, TX(Job Number:708506)

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)

This position is responsible for obtaining all available data relevant to claims investigations to determine the accuracy of all claim type payments prospectively and retrospectively and processing of recoveries.  The Senior Recovery / Resolution Representatives may act as a resource for others and are responsible for independent work without established procedures including analytical investigations that include health plan benefits, contractual obligations and applicable system functions.    
Primary Responsibilities: 
  • Coordinates with the Cost Containment Manager and / or Team Lead on workflow distribution and first in first out handling of correspondence and recovery processes including manual systematic posting and auto recovery by offset by claim payment adjustments
  • Demonstrates depth of knowledge / skills in own area and often able to apply these outside of own function
  • Solves complex problems on own; proactively identifying new solutions to problems
  • Capable of planning, prioritizing, organizing and completion of work to meet established objectives
  • Works with payers / providers to review claim information and identify issues related to payment accuracy which may include initiating telephone calls to gather information
  • Manages conversations with stakeholders to ensure clear understanding and that accurate information is obtained
  • Drives resolution of overpayments based on relevant claims processing information, policies, and regulations
  • Verifies and ensures that received overpayment refund checks are properly applied to the appropriate claims
  • Enters information into applicable systems using predefined parameters to ensure accurate tracking and reporting
  • Addresses concerns/inquiries from providers (e.g., obtaining commitment of provider / other entity to refund by check or permission to offset when indicated
  •  Responsible for maintaining a 95% quality standard and production standard of 7 claims per hour on transactions
  • Reports and monitors overpayment identifications and resolutions in order to establish and measure progress against targets and objectives
  • Identifies implements and reports opportunities to improve processes, procedures and systems to drive improved quality / efficiency and strengthen stakeholder relationships
  • Performs all other related duties as assigned

Job Claim Recovery/Resol/COB/Subro
Primary Location US-TX-San Antonio
Other Location 
Organization WellMed Medical Mgmt, Inc
Schedule Full-time
Number of Openings 2
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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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