Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm) This role will oversee and ensure high quality and accurate responses to state level provider complaints. The position also drives root cause analysis and mitigation plans to resolve provider issues globally with a goal of reducing the number of state level provider complaints year over year. A robust familiarity with state regulator and provider expectations is necessary. Familiarity with the Medicaid plan for the State of Tennessee is highly desired. Primary Responsibilities:Assess and interpret customer needs and requirementsIdentify solutions to non-standard requests and problemsWork across department lines to ensure timely and accurate response to provider complaintsConduct complex analysis of causes of complaints and identify systemic resolution options Provide explanations and information to others on difficult issuesCoach, provide feedback, and guide others
Required Qualifications:4+ years of experience in a provider operations, relationship or network development role 3+ years experience in provider issue identification and resolution2+ years experience with Medicaid plans and regulations2+ years experience working with provider data/claims dataAt least an intermediate level of proficiency with MS ExcelPreferred Qualifications:1+ years experience with CSP Facets and NDBExperience with the Medicaid plan of the state of Tennessee Exceptional presentation, written and verbal communication skillsAbility to work independently and remain on taskGood organization and planning skillsIntermediate level of proficiency with MS Word, and PowerPoint Undergraduate or higher level degreeCareers 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 health care here. We serve the health care 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 health care, community and government partners to heal health care 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. Job Keywords: provider relations, provider network, claims processing issues and resolution, Medicaid, Brentwood, TN, Tennessee
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.