Provider Network Relations Specialist - Cypress, CA
January 5, 2018
Position Description: It's that time, isn't it? You're ready for the next step forward and an opportunity to build on your skills. And it just so happens that there's never been a better time to become a part of the team at UnitedHealth Group. We're driving even higher levels of sophistication in how provider networks are formed and operate. The goal is to improve quality of service while exploring new ways to manage costs. Here's where you come in. You'll use your knowledge of insurance claims and customer service to help create strong relationships with the providers in our networks. As you do, you'll discover the resources, backing and opportunities that you'd expect from a Fortune 6 leader.Taking a giant leap step forward comes with great challenge. You'll ensure provider service quality by making outbound calls to obtain data and verify information with providers as well as perform analysis and develop reports that help clarify operational issues and opportunities.Positions in this function are accountable for the full range of provider relations and service interactions within UHG, including working on end-to-end provider inquiries and call quality, ease of use of physician portal and future service enhancements, and training & development of external provider education programs. Designs and implements programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. Directs and implements strategies relating to the development and management of a provider network. Identifies gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs. May also be involved in identifying and remediating operational short-falls and researching and remediating claims. Employees in jobs labeled with SCA must support a government Service Contract Act (SCA) agreement.Primary Responsibilities:Assist in end-to-end provider inquiries and help enhance call quality Assist in the design and implementation of programs that build/nurture positive relationships between the health plan, providers and practice managersSupport development and management of provider networksHelp implement training and development of external providers through education programsIdentify gaps in network composition and services to assist network contracting and development teamsAcknowledge and resolve formal provider complaints
Required Qualifications:HS Diploma / GED or higher 1+ years experience in a customer service or provider support roleAbility to edit and save documents with MS WordAbility to sort and filter data with MS ExcelAbility work Monday - Friday from 10:30 AM to 7:00 PMPreferred Qualifications:Managed care or medical insurance experienceSoft Skills: Experience in a position requiring excellent oral and written communication skills including telephone etiquetteCareerswith Optum.Here's the idea. We built an entire organization around one giant objective;make the health system work better for everyone. So when it comes to how we usethe world's large accumulation of health-related information, or guide healthand lifestyle choices or manage pharmacy benefits for millions, our first goalis to leap beyond the status quo and uncover new ways to serve. Optum, part ofthe UnitedHealth Group family of businesses, brings together some of thegreatest minds and most advanced ideas on where health care has to go in orderto reach its fullest potential. For you, that means working on high performanceteams against sophisticated challenges that matter. Optum, incredible ideas inone incredible company and a singular opportunity to do your life's bestwork.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: UnitedHealth Group, Provider Network Relations Specialist, Cypress, Customer Service, Provider Support
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.