Overview

Operations function is responsible for providing health care back office operational services as a core function to various segments of UnitedHealth Group. The team has well defined HIPAA compliant processes for its business operations with primary focus on quality of delivery. There are more than 2500 associates in the function who manage all facets of the claims lifecycle for our global partners.

Focus Areas

Pre- Adjudication
UHGIS has extensive exposure and experience in editing and repairing claim data from paper and electronic claims, manual data entry of claim forms, provider & member matching, claims re-pricing and scrubbing capabilities.

Adjudication
Our experience base spans across a variety of claims such as Individual physician, Institutional, behavioral health, pharmacy, dental, etc on multiple platforms and plan designs.

Post Adjudication
Team supports the post adjudication role by managing the rework (adjustments), reviewing requests for reconsiderations and appeals.

Case Installation
Case installation lays down the foundation of claims adjudication, by setting terms and conditions of the policies in the system and allowing customers to access their benefits information online. UHGIS has developed strong expertise in supporting the business partners in this domain too.

Operational Support Services

Transactional Quality & Reporting and Analytics
It ensures the global quality standards are maintained by business operations. Data integrity is managed by our reporting and analytics group and this data is further analyzed for provider negotiations, financial analysis, payer reimbursement arrangement, etc.

Vendor Management
This team performs vendor audits, identifies improvement opportunities and reports progress to management team.

Finance & Accounting
The team is involved in financial reporting, account reconciliations and month end closing activities.