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Senior Recovery / Resolutions Representative - Frederick, MD

UnitedHealth Group

Frederick, MD
Job Code:
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Job Details

Senior Recovery / Resolutions Representative - Frederick, MD(Job Number:729349)

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 and Performance.

The Senior Recovery / Resolution Representative handles information about patient services and how those services are paid by investigating and pursuing recoveries through contact with various parties. 

Primary Responsibilities:
  • Provide claims expertise support by reviewing, researching, investigating, negotiating, and resolving all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities
  • Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
  • Perform other duties as assigned
  • Develops and expands knowledge of COB Rules, basic computer skills and business etiquette 
  • Performs basic and specialty workflow and administrative tasks with minimal supervision
  • Collaborates with others to identify and solve moderate problems and create procedures that promote efficiency and quality
  • Initiates telephone calls to members, providers and other insurance companies to gather COB data 
  • Receives and respond to incoming telephone inquiries
  • Determines primacy using published COB
  • Updates eligibility system / database with outcome of primacy investigation
  • Documents and communicates outcome of investigation following departmental procedures 
  • Meets productivity, quality and timeliness goals 
  • Responds to routine or standard requests to meet customer needs
  • Focuses on customer; exceeds expectations and improves customer experience
  • Makes fact-based decisions; uses sound judgment and applies business knowledge
  • Acts ethically; demonstrates integrity, complies with all laws, regulations and policies

Job Claim Recovery/Resol/COB/Subro
Primary Location US-MD-Frederick
Other Location 
Organization Optum Ops-Payment Integrity
Schedule Full-time
Number of Openings 2
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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