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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.

This role handles information about patient services and how those services are paid by investigating and resolving credit balances through contact with various parties. The intermediate-level Credit Resolution Representative is responsible for the overall management of an assigned provider client’s credit balance inventory and may manage multiple inventory types at any given time. The Credit Resolution Representative will analyze, research, and recommend/take appropriate steps to resolve the credit balance account. Accounts resulting in an overpayment will be monitored by the Credit Resolution Representative through to resolution. Additionally, the Credit Resolution Representative is responsible for the communication with their day-to-day contacts, answering all questions and inquiries that may generate from recommendations made or individual accounts that need addressed quickly. The Credit Resolution Representative will also participate in the weekly/monthly/quarterly presentations with their supervisor or management, regarding credit balance reduction, and recommended actions to keep credit balances within overall required volumes, dollars and age. The Credit Resolution Representative will work closely with their credit balance teammates, areas within the Patient Financial Department, and Leaders to continually improve upon credit resolution timeliness, credit root-cause solutions and operational best practices.

Location: 43 Whiting Hill Road, Brewer, ME 04412

If you are located in Brewer, ME, you will have the flexibility to Work from home and the office in this hybrid role* as you take on some tough challenges.

Primary Responsibilities:

• Provide expertise by reviewing, researching, and resolving all types of accounts in a credit balance to bring final resolution and root cause analysis for health plans, commercial clients and government entities

Fundamental Execution

• Plan, prioritize, organize and complete work to meet established production goals required by provider clients, as well as Optum goals, quotas and deadlines in a fast pace and ever-changing environment

• Provide top quality by researching accounts fully, reviewing and adhering to payer, provider & Optum quality requirements

• Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance

Inventory Management

• Credit Balance follow up and resolution, ensuring required compliance account timeliness guidelines are met within 30/60/180 days. Follow up includes researching why inventory is outstanding and working with Optum management and provider client to ensure resolution

• Manage multiple different inventory work queues and workflows, including multiple payer and provider client referred credit inventory, as well as unsolicited/correspondence inventory

Reporting & Analysis

• Analyze and identify trends and provide reporting as necessary to provider clients, management

• Utilize various workflow applications and reports to manage inventory, follow up as needed & drive client relationships

• Work independently with little direct onsite supervision

• Build relationships with day-to-day contacts at assigned provider; Accounting, customer service, Accounts Receivable, contracting, business support teams, etc

• Collaborate with peers assigned to provider client to make sure best in class principles are applied to all credit balance reduction approaches

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:

• 1+ years of experience in claims recovery and resolution or an operations-based environment

• Proven solid Communication and Customer Service skills

• Proven intermediate level of proficiency with Excel (i.e. sorting, summing, creating bar graphs, formulas)

• Proven exceptional organizational/time management skills

• Ability to work 40 hours standard, OT if business needs dictate but not regular

• Ability to work a hybrid model, this role requires you to work in the office 1 day a week

Preferred Qualifications:

• 3+ years of experience in claims recovery and resolution or an operations-based environment

• 2+ years of Account Management or Customer Service experience

• Proven healthcare finance experience with a focus in auditing and/or analysis

• Demonstrated ability to work in a dynamic environment both independently and in a group setting

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

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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