Recovery and Resolution Analyst - National Remote

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The Recovery and Resolution Analyst position offers an exciting opportunity to be a key voice in shaping the future of the OptumInsight / Warburg Pincus joint venture. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

A Subrogation Analyst is responsible for recovering medical payments when another party is responsible for payment. This position requires the skills to successfully investigate, evaluate, and handle to conclusion injury cases. These may include attorney-represented cases, complex injury cases, and litigated cases. The successful candidate will have advanced case handling skills and a proven track record of high quality results. As a Subrogation Analyst, you will be responsible for identifying cases containing healthcare subrogation opportunities and working with all involved parties to ensure thorough investigation and negotiation of settlements. You will be accountable for all stages of the process from initial contact to review of plan language and negotiation of the plan's subrogation interest. This role is responsible to read and interpret case law, statutes, and regulations and to articulate legal arguments in order to negotiate settlements within authority level to maximize dollars recovered and achieve customers' financial expectations. Individuals in this role will act as a subject matter expert with identifying, communicating, and recovering healthcare dollars as deemed appropriate.

This position is 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 8:00 am - 5:00 pm. It may be necessary, given the business need, to work occasional overtime.

We offer 4 weeks of paid training during normal business.

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

Primary Responsibilities:

• Investigate, evaluate, and negotiate healthcare subrogation matters for a multi-million dollar portfolio up to $20M (70%)
  
  
  
  
  • Comprehend the nuances of Medicare, Medicaid, Self-Funded ERISA and Non-ERISA related health insurance subrogation recoveries and reimbursements to analyze and move cases to recovery for the clients, including the negotiation of dollars that will be returned to the plan
  • Research applicability of laws, regulations and other requirements to cases, contracts or decisions
  • Analyze data and interpret legal research to make conclusions. Present results of analysis in writing and/or verbally to supports the Plan's rights
  • Maintain working knowledge of ERISA and ensure adherence to state and federal subrogation laws
  • Utilize your understanding of and expertise of coverage, policy interpretation, contract interpretation, case law, state/federal regulations Identify, monitor and evaluate data to determine third party liability and reimbursement amounts; ongoing analysis of medical treatment to evaluate relatedness
  
  
  
  
• Conduct a high volume of outbound calls and send out or respond to electronic, written and verbal inquiries to/ from attorneys, insurance companies and health plan members (20%)
  
  
  
  
  • Communicate effectively with various parties using all forms of correspondence throughout the subrogation recovery process. The analyst will correspond with plaintiff's attorney, defense counsel, third party insurers, and all other parties of interest
  • Validate claim liability, adjuster's contact information, claim status, availability of coverage, accident-related injuries and health plan members' treatment status
  
  
  
  
• Thoroughly document all written and verbal communications and maintain case activity calendar diaries (10%)
• Ensure compliance with Health Insurance Portability and Accountability Act
• May be involved with litigation as necessary
• Must be able to act independent of an attorney, present the client's case and negotiate a settlement with an adverse party with professionalism, integrity and vigor
• Recommend and participate in round table discussions of complex cases to determine the best strategic solutions
• Act as coach and mentor to other team members in the development of their subrogation technical skills
• Assist management on special projects and any other assigned tasks

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
• Must be 18 years of age OR older
• An understanding of subrogation principles, health insurance and / OR P&C insurance experience
• Proficiency in Microsoft Office Suite of products
• Ability to work between the hours of 8:00 am - 5:00 pm from Monday - Friday including the flexibility to work occasional overtime based on business need

Preferred Qualifications:

• 2+ years of claims OR collections experience
• Knowledge of local, state and federal laws and regulations pertaining to insurance
• Negotiation experience, specifically in the capacity of persuading and influencing others; ability to negotiate fair settlements consistent with the prevailing subrogation law

Telecommuting Requirements:

• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• 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:

• Candidate must be highly organized with effective and exceptional verbal and written communication skills
• Analytical, problem solving and decision-making skills required; ability to exercise good judgment
• Ability to prioritize work, handle multiple tasks and work independently
• Telephone and customer service skills; ability to interact professionally in challenging situations
• Open to change and new information; ability to adapt behavior and work methods to changing organization and integrate best practices into the subrogation recovery process

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy