01Responsibilities
Analyze medical claims to identify overpayments and recovery opportunitiesValidate claims accuracy using CPT-4, J-codes, and ICD diagnosis/procedure codingInitiate and follow up on recovery processes to secure savingsMaintain accurate and up-to-date documentation of all recovery activitiesCommunicate with internal teams and external stakeholders to resolve discrepanciesEnsure compliance with quality standards and productivity targetsComply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do soRequired Qualifications:
Bachelor's degree (any stream)1+ years of experience in medical claims processing/auditingWorking knowledge of healthcare benefits and provider contractsKnowledge of Medical Claims Analysis & AuditingKnowledge of Overpayment Identification & RecoveryKnowledge of CPT-4, ICD, and J-codesKnowledge of Claims Processing Systems (Healthcare platforms)Knowledge of Collections & Recovery HandlingProven analytical & problem-solving skillsProven attention to Detail & AccuracyProven multitasking & time managementIndependent & Team Collaboration
Personal Attributes
Highly detail-oriented with solid accuracy focusAdaptable and quick learner of new systems/toolsSelf-motivated and performance-drivenAbility to handle multiple priorities effectivelyContinuous improvement mindset
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. .
