Community and State Claims Capability Analyst - Remote
- Employer
- UnitedHealth Group
- Location
- Minneapolis
- Salary
- 53300.00 - 95100.00 USD Annual
View more
- Industry
- Government and Public Services
- Role
- Other
- Job Type
- Long-Term
- Hours
- Full Time
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
People say change is hard. We say so what? We're in the business of making health care more affordable, simpler and easier for people to access. And we need smart business professionals who can help us. This role requires alignment to business strategy, effective design/business solutioning and ongoing management of activities for claims. You will leverage market insights to monitor trends and external landscape, and to inform capability strategies and claims use case scenarios. You will be accountable for delivering sustainable, financially sound solutions that solve a specific problem and enable successful claims delivery and/or internal business function performance, while driving adoption with internal business partners and define future capability direction that supports business strategy and new opportunities.
The selected candidate will become a subject matter expert in the area of Claims operational tasks and delivery of changes impacting claims processing. He or she will be viewed as a trusted partner for Government Operations teams, delivering with clarity, speed, quality and transparency.
While you're busy helping us change the landscape of health care, you've got to be able to quickly adapt to change in a fluid environment. It's all about quality reporting, analysis and audits and developing plans and programs to support continuous quality improvement. You'll also be challenged to gain buy-in from multiple stakeholders before presenting solutions to senior leadership.
Training will be conducted virtually from your home.
*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Primary Responsibilities:
- Lead and manage claims analysis and implementation of change for Community & State
- Review regulatory guidance and requirements for large scaled/complex initiatives and determine how the requirement will be met within the Claims domain
- Responsible for delivery of the Claims capability
- Ensure alignment and understanding of program/project scope and objectives with the organization's strategic objectives, in consultation with applicable stakeholders
- Coordinate with SMEs and other stakeholders to obtain information necessary to define the appropriate process and facilitate and manage workgroups, enabling a culture of collaboration, trust and disciplined accomplishment of tasks and target dates
- Provide guidance and oversight to any configuration changes impacting claims processing
- Provide claims impact and input to the Agile Claims product teams during the build of business requirements/solution capabilities for projects requiring technology changes, with ability to elicit, understand and articulate customer needs.
- Acts as a resource for others; readily shares knowledge
- Ensures operations is protected - e.g. drives solutions that do not require significant adds to staffing, influences direction away from approaches and strategies that Operations cannot administer
- Determine test scenarios and support business testing prior to system changes being deployed in production
- Oversee operational readiness activities/deliverables, such as training to the claims supervisors/SMEs and SOP updates
- Develop SQL queries to monitor and audit claims after system deployments to ensure minimal impact to claims quality
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)
- 3+ years experience within medical claims or payment operations
- 3+ years experience with claims system platforms
- Demonstrated experience in gathering and evaluating requirements and also writing and translating business requirements
Preferred Qualifications:
- Experience working directly with senior level business stakeholders
- Intermediate level with Microsoft Office productions, for example using Excel (editing, creating, updating spreadsheets), Outlook (general navigation), and Visio (editing and creating Visio flows)
Soft Skills:
- Strong working knowledge of how to execute on project deliverables in a fast paced environment
- Ability to develop strong networks and ensure collaboration and consensus building
- An ability to communicate complex issues to diverse audiences
- Ability to hit the ground running and helping to pave the road
- Self-motivated to see the need and find ways to address the need
- Eagar to take on many different tasks while having the ability to fully understand and comprehend
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
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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