Company Name:-
UnitedHealth Group

Job Location:-
Noida, Uttar Pradesh

Job Summary:-
Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get.

Leading edge technology in an industry that’s improving the lives of millions.

Here, innovation isn’t about another gadget, it’s about making health care data available wherever and whenever people need it, safely and reliably.

There’s no room for error.

Join us and start doing your life’s best work.

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This role is responsible for the identification and deployment of new overpaid concepts and implementation of prepay and shift left solutions.

The successful candidate Identify potential concepts for prospective savings through individual ideation and from several perspectives such as correct network contracting, policy reimbursement, medical documentation requirements, industry and federal guidelines.

This role also involves ideation in support of new PrePay opportunities and reviewing ad-hoc/standardized reporting with a view to identifying further savings.

The successful candidate should have prior experience within the U.

S.

HealthCare industry with specific proficiency within reimbursement policy, provider contracts and clinical coding.

Expertise with regards to navigating and understanding UHG core claims platforms (UNET, COSMOS, CSP, NICE etc.

) is a requirement for this role.

Primary Responsibilities:
Review already paid claims data to identify potential leakage and document the requirement
Investigate overpayments on all claims types, as well as assist in resolution for health plans, commercial customers, and government entities as needed
Identify potential concepts for prospective savings through individual ideation and from several perspectives such as correct network contracting, policy reimbursement, medical documentation requirements, industry and federal guidelines
Help those concepts in deployment
Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
Use pertinent data and facts to ideate, identify and solve a range of problems within area of expertise
Ability to build relationships to increase velocity of concept conversion to identifications
Ability to work with less structured, more complex issues
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