Senior Recovery / Resolutions Analyst - Boston, MA(Job Number:703098)
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.
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.
The Senior Recovery / Resolution Analyst will be responsible for triaging, investigating and resolving instances of healthcare fraud and/or wasteful and abusive conduct by health care providers who submit claims for payment. This position will be utilizing information from claims data analysis, plan members, the medical community, law enforcement, employee conduct, and confidential investigations in order to document relevant findings. The analyst will conduct onsite and desk audits of provider claims and/or clinical audits (utilizing appropriate personnel) to gather and analyze all necessary information and documentation related to the investigation, and prepare all necessary reports. The analyst will input information into Optum audit workflow tools and the client’s case tracking system. The analyst will act as a subject matter expert in identifying, communicating and recouping improper payments as deemed appropriate. Where applicable, the analyst will provide appeals and investigative support, as well as testimony.
- Investigate, audit, and resolve all types of Medicaid claims as well as recovery and resolution for government payers
- Process recovery on claims
- Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
- Use pertinent data and facts to identify and solve a range of problems within area of expertise
- The successful candidate will be part of a group of auditors deployed to investigate possible fraud, waste and abuse in Massachusetts
- Generally work is self-directed and not prescribed
- Works with less structured, more complex issues
- Serves as a resource to others
Job Claim Recovery/Resol/COB/Subro
Primary Location US-MA-Boston
Organization Optum Government Solutions
Number of Openings 2