Position 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.SM Our claims operations 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 a 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.As a key member of the team, you will support Benefit Operations, and readiness reviews for external audits. Individual serves a single point of contact for external partners and internal business partners and brings forward to Benefit Operations the audit scope as it relates to operational process reviews and defines operational involvement. This position is a functional SME, has a broad business approach, develops pioneering approaches to emerging industry trends and is a resource to senior leadership. It has oversight of related activities across functional areas and communicates project progress through stage gate reviews and documented adherence action plans in accordance to operational readiness review model.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 contactPartner with functional area leaders and SME's to determine impact and solutionsImplement Claim Ops solutions to meet regulatory requirementsLead 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.
Requirements:High School Diploma / GED5+ years of working experience 3+ years of Healthcare processing experience2+ years of Project Management experience 2+ years of Supervisory or Team Lead experience Knowledge of State and Federal regulations that govern state health insurance claim payment3+ years of experience with Microsoft ExcelKnowledge of CSP Facets and / or COSMOS internal processing platformsAssets:Bachelor's Degree (or higher)Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 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 where ever 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.SMDiversity 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: UHG, UHC, healthcare, project management, medical
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.