Hiring: Work from Home – Claim Investigation Supervisor – National Remote

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life’s best work.^SM

Positions in this function are responsible for investigating, recovering and resolving all types of claims as well as recovery and resolution for health plans, commercial customers and government entities. May include initiating telephone calls to members, providers and other insurance companies to gather coordination of benefits data. Investigate and pursue recoveries and payables on subrogation claims and file management. Process recovery on claims. Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance. May conduct contestable investigations to review medical history. May monitor large claims including transplant cases.

This position is full-time (40 hours/week) Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8am – 5pm. It may be necessary, given the business need, to work occasional overtime.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

• Coordinate and supervise daily/weekly/monthly activities of a team members including setting priorities for the team to ensure task completion and performance goals are met
• Coordinate work activities with other supervisors, managers, departments, etc.
• Identify and resolve operational problems using defined processes, expertise and judgment
• Provide coaching, feedback and annual performance reviews as well as formal corrective action
• Obtain all available data relevant to investigation/overpayment identifications
• Analyze contractual requirements to determine if funds are owed to payers
• Enter information into applicable systems to track processing of claims investigations and/or to ensure that all information relevant to the claim is documented (e.g., SubroTrack, SubroNow, WOW, ODAR, ORS)
• Complete file set up on subrogation/workers’ compensation cases
• Work with payers/providers to review claim information and identify issues related to payment accuracy
• Update applicable claims systems to ensure that claims payments reflect accurate payment levels and appropriate payers (COB, primary vs. secondary payers)
• Document and communicate outcomes of claims investigations/overpayment reviews to applicable stakeholders
• Work with internal and/or external stakeholders (e.g., providers, provider advocates, Network Management) to facilitate resolution of overpayment

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• Associates Degree (or higher)
• 5+ years experience investigating claims on Individually Underwritten Health Insurance policies
• 2+ years experience in claims supervisory role leading, training and guiding staff
• Proficiency using Microsoft Excel (data entry, sorting/filtering, pivot tables)
• Proficiency using Microsoft PowerPoint (create and edit presentations)
• Ability to work full-time Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8am – 5pm. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications:

• Understanding of medical coding methodologies
• 2+ years of experience in health care claims recovery
• 2+ years of experience using claims platforms such as UNET, Pulse, NICE, Facets, Diamond, etc.

Telecommuting Requirements:

• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Ability to keep all company sensitive documents secure (if applicable)
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

California, Colorado, Connecticut, Nevada, New Jersey, New York, Washington or Rhode Island Residents Only: The salary range for California / Colorado / Connecticut / Nevada / New Jersey / New York / Washington / Rhode Island residents is $56,300 – $110,400.Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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