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  • Hartford, CT

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Medicare Set - Aside Specialist - US Telecommute

UnitedHealth Group • Hartford, CT

Posted 1 month ago

Job Snapshot

Healthcare - Health Services
General Business, Health Care

Job Description

Energize your career with one of Healthcare’s fastest growing companies.  

You dream of a great career with a great company - where you can make an impact and help people.  We dream of giving you the opportunity to do just this.  And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our Service Centers, improve our Service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.

This opportunity is with one of our most exciting business areas: Optum - a growing part of our family of companies that make UnitedHealth Group a Fortune 5 leader.

Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions, and treatments; helping them to navigate the system, finance their Healthcare needs, and stay on track with their Health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation, and Performance.

Primary Responsibilities: 

  • Reviews and analyzes medical records, medical payout and detailed pharmacy transaction history information to determine an appropriate Medicare Set Aside (MSA) Allocation for recommendation to client
  • Conducts research on Medicare expenses allowed in appropriate state for workers’ compensation and keeps abreast of all changes in law and Centers for Medicare / Medicaid Services guidelines
  • According to Company MSA Services guidelines, writes the MSA report, calculates financial grid for injury - and non - injury - related medical expenses and coordinates with PMSI for related pharmaceutical costs
  • Works with claim adjusters to obtain clarification on outstanding issues for MSA
  • Works with claim adjusters and attorneys in negotiating and defending recommended allocations as necessary
  • Works with Case Administration Specialists and various departments within the business unit in coordinating daily work deadlines per Company MSA Services’ production standards
  • Maintains level of required quality as determined by Management done through the QC department in monthly evaluations
  • As determined by Management and determined on business needs, maintain a minimum production level
  • Performs other duties as assigned by management

Required Qualifications:
  •  Associate's Degree (or higher)
  • MSCC (Medicare Set-Aside Consultant Certification) OR 12+ months of acceptable full time employment within the past 3 years in any of the following industry disciplines is required-  Acceptable employment means working within the Workers’ Compensation or Liability insurance industry
    State Licensed Adjuster
    Licensed Attorney
    Certified Life Care Planner (CLCP) or Certified Nurse Life Care Planner (CNLCP)
    Certified Case Manager (CCM)
    Registered Nurse (RN) or Licensed Practical Nurse/Licensed Vocational Nurse (LPN/LVN)
  •  1+ years of using Windows PC Applications
  • Telecommuter's will be required to travel to Tampa, FL for 2 weeks of training upon hire. No other travel is required
  • Ability to obtain MSCC (Medicare Set - Aside Consultant Certified) Certification within first 6 months of employment or current certification
 Preferred Qualifications:
  • Bachelor's Degree (or higher) in Business Administration or Insurance
  • Liability claims experience
  • MSP ( Medicare Secondary Payer) experience
Soft Skills:
  • Ability to write and communicate effectively
  • Able to manage one's own time and the time of others
  • Ability to manage strong working relationships, complete tasks and work cooperatively with others
  • Ability to respond and adapt to changing circumstances and to manage, solve problems and provide solutions in a climate of ambiguity
OptumRx is an empowering place for people with the flexibility to help create change. Innovation is part of the job description. And passion for improving the lives of our customers is a motivating factor in everything we do.

If you're ready to talk about groundbreaking interactions, let's talk about what happens when a firm that touches millions of lives decides to gather results from millions of prescriptions every month and analyze their impact. Let's talk about smart, motivated teams. Let's talk about more effective and affordable healthcare solutions. This is caring. This is great chemistry. This is the way to make a difference. We're doing all this, and more, through a greater dedication to our shared values of integrity, compassion, relationships, innovation and performance. Join us and start doing your life’s best work.

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.

Keywords: medical claims, healthcare claims, claims representative, claims rep, claims processing, claims processor; UnitedHealth Group, Optum, training, classes
Job ID: 2551_818992_1
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