Senior Recovery Resolutions Analyst - Franklin, TN(Job Number:698172)
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- Audit paid claims data to identify duplicate payments or contractual, billing, and claim processing errors
- Initiate phone calls to providers, employer groups, and other insurance companies to gather pertinent claim information, such as verification of billed charges, confirmation of services received, and coordination of benefits information
- Work directly with other departments to enhance and refine assigned inventory to maximize value
- 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
- Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization.
- Investigate and identify overpayments on all claims types, as well as assist in recovery and resolution for health plans, commercial customers, and government entities as needed
- 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-TN-Franklin
Organization Optum Ops-Payment Integrity
Number of Openings 21