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UnitedHealth Group Recovery Resolutions Analyst- San Juan, PR in San Juan, Puerto Rico

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 doing your life's best work.(sm)

The Recovery Resolutions Analyst Level 1 individual is relationship focused and responsible for the delivery of value to clients, which includes UnitedHealth Network, UHC Payment Integrity and Professional and Facility Providers. The Analyst is required to understand and interpret clients’ needs and ensure service and delivery excellence supporting the Fraud, Waste, Abuse and Error product suite through the resolution of escalated issues. The Analyst will be responsible for supporting and driving to resolution moderately complex issues with a cross-functional team to proactively review, research and resolve highly escalated inquiries. It is the responsibility of this individual to conduct/utilize investigations to determine accuracy of claims payments (pre-pay) while partnering with UnitedHealthcare to review claim information and identify issues related to payment accuracy. It is imperative to achieve applicable targets/metrics (e.g., production targets, financial targets, quality targets) on a consistent basis to ensure there is minimal impact to NPS/Provider Abrasion.

Primary Responsibilities:

  • Assesses and interprets customer needs and requirements.

  • Identifies solutions to non-standard requests and problems.

  • Solves moderately complex problems and/or conducts moderately complex analyses.

  • Works with minimal guidance; seeks guidance on only the most complex tasks.

  • Translates concepts into practice.

  • Provides explanations and information to others on difficult issues.

  • Work with key matrix partners (e.g., provider advocates, Network Management) to facilitate resolution via telephone and WebEx meetings.

  • Conduct/utilize investigations to determine accuracy of claims payments (pre-pay)

  • Partner with UnitedHealthcare to review claim information and identify issues related to payment accuracy

  • Achieve applicable targets/metrics (e.g., production targets, financial targets, quality targets)

  • Perform other duties as assigned


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:

  • Associate degree or higher degree completed

  • 2+ years of experience in the healthcare industry

  • 1+ years in an audit environment

  • Knowledge with at least 1 claim platform or similar operating system technology

  • Microsoft Office Suite (SharePoint, Excel, PowerPoint, Outlook)

  • This position is full-time (40 hours/week) Monday- Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of (7:00am - 6:00pm). It may be necessary, given the business need, to work weekends and/or occasional overtime

  • Professional proficiency in English

  • Employees are required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener prior to entering the work site each day, in order to keep our work sites safe. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained.

Preferred Qualifications:

  • Bachelor’s Degree

  • Understanding of healthcare compliance/regulatory environments

  • Six Sigma experience/ Lean experience

  • Knowledge of managed care and government operations/products

  • Knowledge in SQL/Macros/databases/IT Certifications

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 do your life's best work.(sm)

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.

Job Keywords: Recovery Resolutions Analyst, Recovery Resolutions Rep, Claims San Juan, Puerto Rico