UH
Requisition number: 2378415
Job category: Claims
This position is National Remote. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
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 FCR Recovery & Resolution Representative (GL23) independently manages complex claim recovery and resolution activities while serving as a functional resource to peers and supporting operational objectives. The role requires broad process knowledge, sound judgment, and the ability to work across multiple lines of business, systems, and workflows. The representative demonstrates accountability, quality, collaboration, and a continuous-improvement mindset.
This position is full-time, Monday-Friday. Employees are required to have flexibility to work an 8-hour shift schedules during our normal business hours of 8:00 am - 4:30 pm. It may be necessary, given the business need, to work occasional overtime.
We offer weeks of on-the-job training. The hours of the training will be aligned to your schedule.
Primary Responsibilities:
Claims Review and Resolution
Independently review and resolve moderately to highly complex claims, appeals, reconsiderations, and recovery opportunities.
Analyze claim information and supporting documentation to determine the appropriate action.
Apply applicable business rules, policies, procedures, and client requirements to support accurate and timely resolution.
Use sound judgment to research issues, identify next steps, and escalate when appropriate.
Operational Execution
Manage assigned inventory and priorities to support established quality, productivity, and timeliness expectations.
Monitor work status, aging, and service-level commitments; communicate risks or barriers promptly.
Document actions and outcomes clearly and consistently in applicable systems.
Support special projects, pilots, and operational initiatives as assigned.
Cross-Functional Expertise
Demonstrate proficiency across multiple workflows, claim types, lines of business, and systems.
Adapt to changing priorities, procedures, client requirements, and business needs.
Provide backup coverage across functional areas and assist with complex or time-sensitive work.
Knowledge Sharing and Team Support
Serve as a functional resource for peers by answering process questions and sharing best practices.
Assist with onboarding, training, mentoring, job aids, and knowledge-transfer activities.
Support senior team members with special requests, workload coordination, and operational needs.
Contribute to a collaborative, respectful, and team-centered work environment.
Client and Stakeholder Support
Respond to client and stakeholder inquiries professionally, accurately, and within expected timeframes.
Support issue resolution and provide clear status updates when additional research or follow-up is required.
Build effective working relationships with internal partners and cross-functional teams.
Continuous Improvement
Identify recurring issues, process gaps, rework drivers, and opportunities to reduce manual effort.
Participate in root-cause discussions and recommend practical process or reporting improvements.
Help test, document, and adopt approved workflow, system, or reporting enhancements.
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:
High School Diploma / GED or equivalent yrs of work experience
Must be 18 years of age or older
Proficiency in claims recovery, resolution, or a related operational environment.
Experience with computers and Windows based programs including Microsoft office suite: Microsoft Word, Microsoft Outlook, Microsoft Teams, Microsoft Excel (view, sort, filter)
6+ months of experience working in a medical office, healthcare facility or medical insurance company
Experience serving as a peer resource, trainer, mentor, or backup for senior-level processes
Ability to work full-time, Monday-Friday. Employees are required to have flexibility to work an 8-hour shift schedules during our normal business hours of 8:00 am - 4:30 pm. It may be necessary, given the business need, to work occasional overtime.
Preferred Qualifications:
Experience with Co-pilot/Chat GPT or other AI Assistants
Experience supporting appeals, reconsiderations, complex recovery activity, or multiple FCR workflows.
Experience contributing to process improvement, reporting enhancement, pilot, or documentation efforts.
Telecommuting Requirements:
Ability to keep all company sensitive documents secure (if applicable)
Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.
Soft Skills:
Ability to manage increasingly complex claim scenarios with limited day-to-day direction.
Strong analytical, problem-solving, decision-making, and research skills.
Effective written and verbal communication, collaboration, and organizational skills.
Ability to learn and navigate multiple systems, workflows, and lines of business.
Consistent attention to quality, accuracy, documentation, and timely follow-through.
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $18 - $32 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
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.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.