Job details
Job type full-time
Full job description
You’ll enjoy the flexibility to telecommute* from anywhere within the u.sAs you take on some tough challengesTraining will be conducted virtually from your home.
Energize your career with one of healthcare’s fastest growing companies.
You dream of a great career with a great company – where you can make an impact and help peopleWe dream of giving you the opportunity to do just thisAnd with the incredible growth of our business, it’s a dream that definitely can come trueAlready one of the world’s leading healthcare companies, unitedhealth group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier livesWe live for the opportunity to make a difference and right now, we are living it up.
This opportunity is with one of our most exciting business areas: optum – a growing part of our family of companies that make unitedhealth group a fortune 10 leader.
Optum helps nearly 60 million americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goalsNo other business touches so many lives in such a positive wayAnd we do it all with every action focused on our shared values of integrity, compassion, relationships, innovation & performance.
As a specialist claim analysis and remediation - behavioral health , you will be proactive and reactive claims analysis and resolution of issuesResponsible for evaluating system configuration, provider and member records, claim adjudication processesResponsible for identification and day to day management of process improvement initiatives, proactive monitors and other opportunities to enhance claim adjudication processesOccasional escalated support for claim payment and processing questions and resolution.
Role primarily serves internal customers in support of the company mission to help the health system work better for everyone.
*all telecommuters will be required to adhere to unitedhealth group’s telecommuter policy.
Primary responsibilities:
Work independently while meeting appropriate deadlines consistently
Work with minimal guidance; seeks guidance on only the most complex tasks
Act as a resource for others – primarily within the department, but also representing behavioral health claim operations across the enterprise
Coordinate own activities, work is self -directed and not prescribed
Plan, prioritize, organize, and complete work to meet established objectives
Identify and resolve complex process problems using expertise and judgment
Development and documentation of processes for accurate and efficient issue research and claim payment
Anticipate customer needs and proactively identifies solutions
Recommend remediation steps for non-claim root causes
Influence business partners to adopt recommended process changes
Serve as the liaison to a complex customer base to manage response and resolution of process challenges
Analyze claim performance to identify relevant patterns/trends, take action where appropriate and communicate to applicable stakeholders (e.g., leadership reports, quality dashboards)
Lead cross-functional projects and discussions to remediate issues impacting accurate and efficient issue resolution
Serve on applicable cross-organizational committees/work groups to identify/ communicate common issue resolution quality issues, trends and patterns
Identify, communicate, and implement opportunities for improving issue resolution processes
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 experience in operations or operations support role and experience understanding operations concepts (e.g., turn-around time, inventory management, quality programs, volume per hour)
3+ years of experience in the healthcare industry (e.g., billing practices, terminology, legal/regulatory requirements, coding standards, healthcare reform)
3+ years of experience with csp facets processing systems and handling all aspects (configuration & set up)
2+ years of experience with process improvement concepts (e.g., six sigma, continuous improvement, process design, piloting, change management, change communication)
2+ years of experience with facilitating execution plans including developing a detailed and workable plan, establishing progress measures, monitoring the plan, and communicating plan implementation and progress on a regular basis.
Advanced knowledge microsoft office
Microsoft word (create and edit correspondence)
Microsoft excel (ability to create, edit, and sort spreadsheets, create and modify pivottables, leverage advanced analytical formulas (lookup, match, if), apply nested formulas)
Microsoft outlook (email and calendar management)
Microsoft powerpoint (ability to create and edit slides)
Microsoft teams (creating correspondence and real time communication)
Preferred qualifications:
Bachelor’s degree (or higher)
Experience with obh facets and cosmos
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:
Comfort with tight deadlines and acting with a sense of urgency
Demonstrated success managing self, including seeking and addressing relevant feedback, aligning present and future needs, and deploying best self against goals.
Leading with resiliency and resourcefulness, including anticipating and preparing for adversity, rebounding quickly, and maintaining calm and focus under pressure.
Making customer centric decisions, monitoring customer needs, expectations, and satisfaction, building and maintaining a customer mindset in the team.
Success fostering innovation, including scanning for environment changes and applicability to the operation, being adaptive and creative, building and maintaining an environment to challenge the status quo, and supporting the generation and combining of ideas.
Assessing the nature of the decisions to be made, including identifying the best decision strategy, evaluating outcomes of the decisions, and debriefing on the process to identify lessons of the future.
Demonstrated knowledge of company mission and values
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 thatUnitedhealth group values the skills, experience and dedication that serving in the military demandsIn fact, many of the values defined in the service mirror what the unitedhealth group culture holds true: integrity, compassion, relationships, innovation and performanceWhether 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 journeyLearn more at https://uhg.hr/transitioning-military
Learn how teresa, a senior quality analyst, works with military veterans and ensures they receive the best benefits and experience possibleHttps://uhg.hr/vet
Careers with optumHere`s the ideaWe built an entire organization around one giant objective; make the health system work better for everyoneSo when it comes to how we use the world`s large accumulation of health - related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serveOptum, part of the unitedhealth group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potentialFor you, that means working on high performance teams against sophisticated challenges that matterOptum, incredible ideas in one incredible company and a singular opportunity to do your life`s best workSm
Colorado residents only: the salary range for colorado residents is $79,700 to $142,600Pay is based on several factors including but not limited to education, work experience, certifications, etcAs of the date of this posting, in addition to your salary, uhg offers the following benefits for this position, subject to applicable eligibility requirements: health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; employee assistance program; pto; and employee-paid critical illness and accident insurance.
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 workplaceCandidates are required to pass a drug test before beginning employment.
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