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Our tools allow you to intensify recovery efforts and have confidence that claims are paid by appropriate parties. Motor vehicle accidents, medical negligence, work-related accidents, premise liability, and defective product injury cases are among those investigated to determine liability responsibility.
Applying proprietary analytics techniques developed by trained biostatisticians, OptumInsight mines claims data and identifies accident-related injury cases on a daily basis. Claims history can be reviewed, and first- through fourth-level diagnosis codes are scrutinized to determine if potential third-party liability exists.
When a case is identified for injury coverage coordination, OptumInsight investigators initiate mail and telephone communications with the plan member. Fifty dedicated call center professionals, including bilingual staff, accept member calls daily. Accurate case identification and communication help close 90 percent of claims within 15 calendar days.
OptumInsight investigators can coordinate with other insurance carriers to apply workers’ compensation, automobile policies, and other coverage before the health insurer addresses claims. If the health plan has already paid, OptumInsight subrogation professionals negotiate and, when necessary, litigate to secure reimbursement on the health plan’s behalf.
