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Senior Claims Business Process Consultant - US Remote

Company: UnitedHealth Group
Location: Zephyrhills
Posted on: May 5, 2021

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.SMUHC may delegate claims processing to a provider entity to perform on our behalf. In those situations, UHC provides oversight to ensure that the delegated entity is supporting a constituent experience on par with UHC.This position will drive the development of data analytics and tools to optimize the claims delegate oversight and monitoring processes, as well as, the process to assess potential provider contracts for future risk-based reimbursement arrangements. This position will identify trends and issues to be addressed by the delegated entity. It will be responsible for enhancing the overall production and quality of work by the development of tools that generate automation and the use of data analytics. The role will be instrumental in supporting each workflow process within the Delegation Oversight and Operations team, by streamlining manual processes and converting them to automated and more effective processes that will maximize production.You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Training will be conducted virtually from your home.* All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.Primary Responsibilities:* Delivering analytics for all claim's universe submissions from provider delegates, identifying trends, and solution driven outcomes to educate provider delegates on errors* Developing tools that automate and enhance the current provider end to end risk-based contract intake and evaluation process (PBR). This includes the intake, pre-assessment, and audit oversight processes* Incorporating the use of the provider delegate encounter data to compare and analyze with the claim universe data, producing analytics that will identify trends/errors* Provide appropriate subject matter expertise, business analysis, and training as required to the provider delegates to submit accurate and timely data* Develop in depth reporting and trending of the data. Identifying potential compliance issues that can be addressed via training and education of the delegates* Collaborate with internal partners i.e. encounters on ensuring the reconciliation of data is complete and accurate* Assist with development of audit tool that will validate DOFR and system benefit set upYou'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:* Bachelor's degree (or higher)* 3+ years of experience using operational metrics, data/analytics, and dashboards to run, interpret, and drive compliant data reporting* 1+ years of experience developing and implementing business process change initiatives, including documentation* Advanced knowledge of Microsoft Excel - Ability to understand combinations of excel formulas. Examples include IF, VLOOKUP, INDEX MATCH, LEFT, RIGHT, MID, FIND VALUE, SEARCH, COUNT IFS, SUM IFS. Knowledge of Pivot tables and data connections.* Knowledge of building and using Microsoft Access relational databases, with ODBC connection setup experience.* VBA read / write knowledge to build new and/or adjust current macros (specifically as data input changes).* Experience with developing macros using other automation tools a plus.* If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or similar UnitedHealth Group-approved symptom screener. When in a UnitedHealth Group building, employees are required to wear a mask in common areas. In addition, employees must comply with any state and local masking ordersPreferred Qualifications:* Experience in the Health Care industry* Experience working with regulatory compliance or quality adherence* Claims operations backgroundSoft Skill:* Highly efficient with relationship skillsUnitedHealth Group is an essential business. The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. At this time, 90% of our non - clinical workforce transitioned to a work at home (remote) status. We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us. You can learn more about all we are doing to fight COVID-19 and support impacted communities at: Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 10 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.SMColorado Residents Only: The salary range for Colorado residents is $64,800 to $116,000. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As 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 workplace. Candidates are required to pass a drug test before beginning employment.Keywords: UnitedHealth Care, UHC, Claims, Consultant, Auditing, work at home, work from home, WAH, WFH, remote, telecommute, hiring immediately, #rpo

Keywords: UnitedHealth Group, Brandon , Senior Claims Business Process Consultant - US Remote, Professions , Zephyrhills, Florida

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