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Claims Business Process Consultant - Remote

Employer
UnitedHealth Group
Location
Minneapolis
Salary
53300.00 - 95100.00 USD Annual

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You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work. SM

Position is responsible for end-to-end oversight of assigned delegates. Works with internal business partners and external providers to ensure the overall compliance of provider delegates where UHC has contracted to delegate claims payments on behalf of UHC's members, as well as ensure a consistent member experience for all lines of business. The position is responsible for ensuring a collaborative relationship with the delegates providing support and educating the delegates appropriately of updated requirements/ changes. Ensuring that outcomes of all oversight activities are completed timely, accurately and documented correctly.

This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm.

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Primary Responsibilities:

  • End to end accountability for the oversight and monitoring of claims compliance of our provider delegates that have been contracted with UHC to process claims on behalf of our members. Includes ensuring a consistent member experience to contribute to an improvement in NPS.
  • Ensure proper oversight of all assigned delegates by the maintenance of the delegate roster and all applicable department tools. Along with Reporting expectations
  • Drive efficiency through conducting quality audits that will identify risk areas within the group. Ensure timely remediation of issues identified by the delegates.
  • Ensure that new regulations/guidelines are incorporated with the current audit standards to ensure oversight occurs on changes
  • Handle and address legal and regulatory inquiries and/or complaints related to the delegated claims providers
  • Collaborate with internal communication lead to ensure regulatory/contractual guidelines and trainings are provided to the provider delegates.
  • Partner with UHN business partners, as appropriate, related to provider delegates that are not performing in accordance with compliance or UHC's performance standards to ensure remediation efforts are resolved timely

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 / GED (or higher)
  • 5+ years of claims / audit experience
  • 5+ years of experience working with regulatory compliance or quality adherence (Medicare, Commercial and Medicaid)
  • High proficiency with Microsoft office Excel (ability to create, edit, and sort spreadsheets, basic analytical formulas (VLOOKUP, if), sort, pivot, formulas), Microsoft Word (create and edit correspondence), Microsoft Outlook (email and calendar management), and Microsoft PowerPoint (Ability to create and edit slides)

Preferred Requirements:

  • Bachelor's Degree (or higher)
  • Experience in the Health Care industry
  • Black Belt or similar ability to design new processes
  • Change Management experience

Telecommuting Requirements:

  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
  • Ability to keep all company sensitive documents secure (if applicable)
  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Soft Skills:

  • Highly efficient with relationship skills
  • High proficiency presenting (verbal and written) complex operational information
  • Intellectually curious
  • Bias for action

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible.

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 5 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near - obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, Military families and Veterans wherever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work. SM

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $53,300 to $95,100. The salary range for Connecticut / Nevada residents is $58,800 to $104,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives

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.

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