Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doingyour 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. Work is frequently completed without established procedures.
Primary Responsibilities:
Provide expertise claims support by reviewing, researching, investigating, negotiating and resolving all types of claims as well as recovery and resolution for health plans, commercial customers and government entities.
Analyze and identify trends and provides reports as necessary
Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance
Work independently
May act as a resource for others
May coordinate others' activities
Comply 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 so
Required Qualifications:
Completed at least 2nd year in college
At least 6 months of Healthcare BPO experience handling Claims, Benefits, and Eligibility
Prior stable work experience
Moderate proficiency with Windows PC applications, which includes the ability to learn new and complex computer system applications
Ability to navigate a computer while on the phone
Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product
Ability to remain focused and productive each day though tasks may be repetitive
Available to work 40 hours per week anytime within the operating hours of the site
Preferred Qualifications:
Preferably with working internet connection of at least 15 mbps in case of working from home. The following options are also available:
- Corporate internet subsidy for those within available and valid serviceable locations, subject to Company Policy
- Onsite work for those who are amenable to drive or commute to our office locations
Careers with Optum.Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to doyour life's best work.(sm)
Diversity creates a healthier atmosphere: Optum is an Equal Employment Opportunity 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.
Optum is a drug-free workplace. © 2021 Optum Global Solutions (Philippines) Inc. All rights reserved.
Job Keywords: BPO Healthcare Claims Representatives, Claims, Benefits, Eligibility, Contact Center, Call Center, BPO, Business Process Outsourcing, Quezon City, NCR, National Capital Region
