FCR Recovery and Resolution Representative

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.

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.