Optum Logo

Optum

Healthcare Investigation Representative

Reposted 8 Days Ago
Be an Early Applicant
In-Office
Makati City, Metro Manila, National Capital Region
Mid level
In-Office
Makati City, Metro Manila, National Capital Region
Mid level
Investigate, research, negotiate, and resolve health claims, manage subrogation files, analyze trends and report findings, and ensure compliance with state, federal, reimbursement, and contract policies.
The summary above was generated by AI
Requisition Number: 2335235
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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
The health care system is still evolving at a rapid pace. Technology is driving new advances in how patient care is delivered and how it's reimbursed. Now, UnitedHealth Group invites you to help us build a more accurate and precise approach to claims adjudication. As part of our Recovery and Resolutions team, you'll help understand and overcome errors in claims processing. You'll have all the tools and backing you need to help manage subrogation files, negotiate settlements and ensure adherence to compliance policies.
Primary Responsibilities:
  • Provide claims expertise 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, identify trends and provide reports as necessary
  • Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance
  • Manage subrogation files
  • 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

This is a challenging role with serious impact. You'll need to sort through complex situations to understand and clarify where errors happened or where they may continue to happen. It's a fast paced environment that takes focus, intensity and resilience.
Required Qualifications:
  • College graduate or equivalent work experience
  • 3+ years of claims or collections experience
  • 3+ years of experience analyzing and solving customer problems

Preferred Qualifications:
  • Experience working with subrogation
  • Experience with negotiations
  • Experience working in the health care industry

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.
Optum is a drug-free workplace. © 2025 Optum Global Solutions (Philippines) Inc. All rights reserved.

Optum New Delhi, Delhi, IND Office

New Delhi, India, India

Similar Jobs at Optum

Yesterday
In-Office
Entry level
Entry level
Artificial Intelligence • Big Data • Healthtech • Information Technology • Machine Learning • Software • Analytics
Review, investigate, and resolve claims while ensuring compliance with policies. Analyze trends and provide reports. Requires strong problem-solving skills.
Top Skills: Claims ProcessingData AnalysisHealthcare Compliance
Yesterday
In-Office
Entry level
Entry level
Artificial Intelligence • Big Data • Healthtech • Information Technology • Machine Learning • Software • Analytics
Review, investigate, and resolve claims while ensuring compliance with policies. Analyze trends and provide reports. Requires strong problem-solving skills.
Top Skills: Claims ProcessingData AnalysisHealthcare Compliance
Yesterday
In-Office
Entry level
Entry level
Artificial Intelligence • Big Data • Healthtech • Information Technology • Machine Learning • Software • Analytics
Join Optum to improve health outcomes by delivering care and connecting individuals with medical resources. Responsibilities include compliance with company policies and problem-solving skills in a team setting.

What you need to know about the Delhi Tech Scene

Delhi, India's capital city, is a place where tradition and progress co-exist. While Old Delhi is known for its rich history and bustling markets, New Delhi is defined by its modern architecture. It's clear the region places a strong emphasis on preserving its cultural heritage while embracing technological advancements, particularly in artificial intelligence, which plays a central role in shaping the city's tech landscape, fueled by investments in research and development.

Sign up now Access later

Create Free Account

Please log in or sign up to report this job.

Create Free Account