Recovery \/ Resolution Exploratory Consultant - Remote

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM


Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

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

This position is full-time (40 hours/week) Monday - Friday. Employees are required to work our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends.

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

Primary Responsibilities:
  • Identify patterns of claim payment abnormalities that will lead to new rule development through data and claim analysis
  • Identify patterns of claim payment abnormalities that will lead to one off payment error identification
  • Research new overpayment leads for viability
  • Populate client's test file templates and gather all supporting documentation for trend approval
  • Assist on client calls with the presentation of new rules for client approval
  • Facilitate new rule kick off calls with Operations, Centers of Excellence, and the recovery team
  • Weekly management reports outlining work completed and issues encountered
  • Competencies and Best Practices for High Performers
  • Breakdown complex problems into individual root causes
  • Perform vendor analysis and present findings to management teams
  • Quickly identify payment errors regardless of claim system by means of effective data analysis
  • Identify and refine criteria to successfully increase efficiency of rule logic
  • Serve as a team lead in the absence of the Operations Manager
  • Subject matter expert on client processes and policies
  • Train analysts within and outside of Operations
  • Lead on Implementation of solutions on overpaid claims to prevent re-occurrence
  • Lead special projects with little to no manager supervision or assistance
  • Perform validation steps for new client implementations
  • Provider outreach to network and providers to explain the root cause for overpayments and education to prevent overpayments going forward
  • Lead on the development of new referrals by conducting detailed forensic analysis in compliance with relevant business and industry polices/guidelines
  • Present out to Senior Leadership when seeking approval for the deployment of a concept, providing technical clarity and clear solution vision
  • Develop new ideation and Growth techniques and skills, utilizing various business and external sources of intelligence/knowledge
  • Collaboration with key Business partners across the organization to enhance value to achieve targets for pre/post pay savings

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:
  • Bachelor's Degree (or higher) OR HSD / GED with 3+ years of health care experience working with claims data and / or medical codes
  • 1+ years of experience working with processing and reviewing medical claims platforms
  • 2+ years of health care experience working with claims data and / or medical codes
  • 2+ years of experience with medical claims auditing and researching medical claims information
  • 2+ years of experience using at least one of the following claims platforms: Cosmos, NICE
  • Experience reading and interpreting provider contracts, fee schedules, and claim payment policies

Preferred Qualifications:
  • Experience in healthcare
  • Experience with claims auditing/processing
  • Coding Certification: CPC, CPC-P, COC, CCS, or CCA, CCS-P
  • Experience with Medicare payment policies and methodologies
  • Intermediate level of proficiency working with Microsoft Excel including formulas, calculations, charts, graphs, 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

Soft Skills:
  • Experience analyzing large data sets to determine trends / patterns

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible.

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 or Nevada Residents Only: The salary range for Colorado residents is $31.15 to $55.77. The salary range for Connecticut / Nevada residents is $34.33 to $61.25. 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.

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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