UnitedHealth Group
Senior Claims Business Process Consultant - US Telecommute
At a glance
Location: US-AZ-Phoenix Map
Posted: 11/10/2019
Closing: 12/09/2019
Degree: Not Specified
Type: Full-Time
Experience: Not Specified
UnitedHealth Group
Job description

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.

Our claims operations, including our Senior Claims Business Process Consultants, are the focal point of handling information about services patients receive and the way those services get paid. It's complex, detailed work. It's fast paced challenge. It's a job that calls on you to be thoughtful, resourceful, team-driven and customer-focused. To put it mildly, there is never a dull moment.

Primary Responsibilities:
  • Implement claim payment processes that meet regulatory requirements and claim business rules. 
  • Conduct claims systems utilization, capacity analysis/planning and reporting, and claims-related business and systems analysis.
  • Ensure data integrity, data security and process optimization.
  • Serve as our internal Regulatory Affairs' point of contact.
  • Partner with functional area leaders and SMEs to determine impact and solutions.
  • Implement Claim ops solutions to meet regulatory requirements.
  • Lead Claim Ops market conduct or financial exam activity, corrective action plans responses and restitution projects.
  • Remediate gaps in existing production processes that do not meet regulatory requirements.
  • At least an intermediate level of proficiency working with MS Excel including use of formulas, calculations, charts, graphs, etc.
  • Positions in this function are responsible for all related aspects of claim system processes and claim business rules.
  • Reviews the work of others.
  • Develops innovative approaches.
  • Sought out as expert.
  • Serves as a leader/ mentor.

Required Qualifications:

  • Undergraduate Degree OR High School Diploma / GED (or higher) with 3+ years of claims experience, preferably in Medicaid managed care environment
  • Intermediate knowledge of State and Federal regulations that govern health insurance claim payments
  • 3+ years of claim coding and editing experience
  • Advanced proficiency with Microsoft Excel, including V-lookup, Pivot Tables and Concatenation
  • 3+ years of SQL experience (running queries; ad-hoc, monthly)
  • Ability to work Monday - Friday 8am-5pm AZ time zone; additional hours may be needed based on business needs

Preferred Qualifications:

  • Beginner proficiency with FACETS
  • CPT Certification
  • Beginner knowledge of Medicaid laws

Soft Skills:

  • Excellent time management, organizational, and prioritization skills and ability to balance multiple priorities and make changes as needed.
  • Must be able to work within a team, lead a team and work independently.

Careers at UnitedHealthcare Community & State. Challenge brings out the best in us. It also attracts the best. That's why you'll find some of the most amazingly talented people in healthcare here. We serve the healthcare needs of low income adults and children with debilitating illnesses such as Cardiovascular Disease, Diabetes, HIV / AIDS and High - risk Pregnancy. Our holistic, outcomes - based approach considers social, behavioral, economic, physical and environmental factors. Join us. Work with proactive Healthcare, Community, and Government partners to heal healthcare and create positive change for those who need it most. This is the place to do your life’s best work.SM

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.

Keywords: UnitedHealth Group, UnitedHealth Care, Health care, claims, claim coding, claim editing, Advanced Excel, SQL

Senior Claims Business Process Consultant - US Telecommute