Recovery/Resolution Representative
UnitedHealth Group 2,443 reviews - Franklin, TN

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Description :
Performs routine and specialty COB investigations, determines primacy of other coverage for members who have two or more health policies in order to avoid overpayment payment of claims, populates data into eligibility systems, appropriately communicates results and develops subject matter expertise in one or more workflows or eligibility systems

Performs basic and specialty workflow and administrative tasks with minimal supervision

Collaborates with others to identify and solve moderate problems and create procedures that promote efficiency and quality.

Initiates telephone calls to members, providers and other insurance companies to gather COB data

Receives and respond to incoming telephone inquiries

Determines primacy using published COB guidelines

Updates eligibility system/ database with outcome of primacy investigation

Documents and communicates outcome of investigation following departmental procedures

Meets productivity, quality and timeliness goals

Responds to routine or standard requests to meet customer needs

Develops subject matter expertise in COB rules, departmental procedures and/or multiple eligibility systems

Develops and expands knowledge of COB rules, basic computer skills and business etiquette


1-2 years customer service or data entry experience

Strong Customer Service skills

Good skill with Microsoft Office; WORD, EXCEL, PP

Acts as a Team Player; collaborates well, learns and develops self

Focuses on Customer; exceeds expectations and improves customer experience

Makes fact- based decisions; uses sound judgment and applies business knowledge

Delivers results: meets/exceeds productions, quality and timeliness goals

Supports change and innovation; works effectively with and contributes to new ideas

Communicates effectively; speaks and writes clearly, listens actively and influences others

Acts ethically; demonstrates integrity, complies with all laws, regulations and policies

Physical Requirements and Work Environment:
Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouse

Office environment

UnitedHealth Group is working to create the health care system of tomorrow.

Already Fortune 25, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we’re doing a lot of good.

Through our family of businesses and a lot of inspired individuals, we’re building a high-performance health care system that works better for more people in more ways than ever. Now we’re looking to reinforce our team with people who are decisive, brilliant – and built for speed.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

About this company
2,443 reviews
UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier...