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Job Information

UnitedHealth Group Recovery Resolutions Representative- San Juan, PR in San Juan, Puerto Rico

If you want to achieve more in your mission of health care, you must be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work. (sm)

The Recovery Resolutions Representative supports the two parts of the Prospective Investigations process by identifying and keying specific detail from the medical records and determine if the claims proceed with a payment. Incumbents are responsible for dealing professionally and ethically safeguarding confidential information, adhering to UHG’s Principles of Integrity and Compliance. This position is critical to the success of the Investigative teams and their ability to meet required internal and mandated turn-around times.

Primary Responsibilities:

  • Data enter key detail from the medical records and claim platform into an online communication

  • Meet required productivity and quality metrics

  • Adherence to state and federal compliance policies and contract compliance

  • Assist the prospective team with special projects and reporting


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

  • 1+ year of experience within a Healthcare environment using the computer as the primary instrument to perform job duties

  • Production environment experience

  • Medical record familiarity

  • Working experience with Microsoft Tools: Microsoft Teams (join meetings and trainings), Microsoft Power Point (prepare presentations), Microsoft Word (creating memos, writing), Microsoft Outlook (setting calendar appointments, email) and Microsoft Excel (creating spreadsheets, filtering, navigating reports)

  • Available to work (40 hours/week) Monday - Friday. Flexible to work any of our 8-hour shift schedules during our normal business hours of (6:00am to 6:00pm EST). It may be necessary, given the business need, to occasionally work mandatory overtime, holidays or weekends.

  • English proficiency

Preferred Qualifications:

  • Nursing degree

  • Coding experience

  • Managed care experience

  • Claims processing experience

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone, so when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care must go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work. (sm)

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.

Job Keywords : Recovery Resolutions, Medicare, Fraud, FWAE, Claims, Coding, Nursing, Medical Record, Payment Integrity, San Juan, PR, Puerto Rico