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

Combine two of the fastest - growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making Healthcare data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life’s best work. SM

The Optum Health Behavioral Solutions (OHBS) SIU Recovery / Resolutions Analyst is responsible for investigating, recovering and resolving suspect and / or potentially fraudulent Behavioral Health claims that have been flagged for review of claims as well as recovery and resolution for health plans, commercial customers and government entities. Utilizing a combination of technological platforms, designated resource tools and individual expertise, the individual is expected to work through daily claims files to make line level adjustment on appropriateness of payment. This position serves as a recovery and resolution expert in the SIU as part of its overall fraud, waste and abuse (FWA) recoveries.

This position is full - time. Employees are required to work our normal business hours of 8:00 AM - 5:00 PM CST (Central Standard Time zone). Training will be conducted virtually from your home.

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

Primary Responsibilities:

• Conducts detailed reviews on claims that have been identified as suspicious and / or potentially fraudulent, utilizing most current reference materials to include, but not limited to: Current Procedural Terminology (CPT), Internal Classification of Disease - 9th Edition (ICD - 9), and Healthcare Common Procedure Coding System (HCPCS) guidelines
• Documents decisions on denied claims with thorough notations and enters these notes into company designated systems
• Must be able to discuss these decisions with SIU team members, inter - departmental personnel, providers, law enforcement, state and federal agencies or designated billing personnel as required to educate and correct billing issues
• Receives and scans incoming SIU appeals, reevaluate previous claim decisions based on provided documentation and research coordinate with company personnel as required in making final determination, and informs providers of decisions
• Coordinate with SIU team members to continually provide updates on newly identified billing / coding trends, suspicious providers, gaps in clinical policy, provider contract issues, system configuration and pricing errors, claims processor errors (manual or system processed), and provide leads on potential post - payment investigations
• Monitor and participate with national and regional information sharing groups with a focus on collecting data to recognize national trends or schemes to proactively anticipate threats
• Receives and resolves claims adjustments related to SIU recoveries and reconsiderations
• Acts as SIU Claims resource for all lines of business

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:

• High School Diploma / GED (or higher)
• 2+ years of claims OR collections experience
• 1+ years of experience with analyzing and solving customer problems
• Experience with one OR more of the following: Claim processing , Provider demographic information , and / OR Insurance billing practices
• Intermediate (or higher) experience with Microsoft Office: Microsoft Word (create and edit documents) and Microsoft Excel (sort and filter data)
• Experience with using claims platforms such as UNET, Pulse, NICE, Facets, Diamond, etc.
• Ability to work any shift between the hours of 8:00 AM - 5:00 PM CST (Central Standard Time zone)

Preferred Qualifications:

• Experience in anti - FWA activities to include SIU OR Program Integrity Units / Programs OR Overpayment Recovery teams
• Intermediate level of knowledge with CMS 1500 and UB04 data elements
• Intermediate level of experience with standard industry coding guides such as CPT, HCPCS, ICD - 9, and Revenue Codes

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

Soft Skills:

• Strong organizational / time management skills and be able to work independently, exercising judgment, and utilizing claims and coding expertise

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies required all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers with OptumInsight . Information and technology have amazing power to transform the Healthcare industry and improve people's lives. This is where it's happening. This is where you'll help solve the problems that have never been solved. We're freeing information so it can be used safely and securely wherever it's needed. We're creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place to do your life’s best work. SM

Colorado, Connecticut, Nevada or New York City Residents Only: The salary range for Colorado residents is $21.68 - $38.56. The salary range for Connecticut / Nevada / New York City residents is $23.94 - $42.40. 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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