Claims Business Process Consultant - National Remote

You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.At UnitedHealthcare , we’re simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us and start doing your life’s best work. SMThis position is full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00am – 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends.We offer weeks of on-the-job training. The hours during training will be 8:00am to 5:00pm, Monday - Friday. Training will be conducted virtually from your home.All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.Primary Responsibilities:

Participate in the implementation and management of claim operational strategies, policies, workflow processes and standards and ensure effective utilization of them.

Function as a liaison to service vendors and business partners to align service delivery with strategic objectives and priorities; Assist in handling escalated service issues.

Assist with the management of the Claim Processing Team by handling escalated claims processing and benefit configuration question.

Assist with the management of complex claims issues such as coordination of benefits and adjustments.

Assist with the management of complex overpayments and refund processes including auto recoupment of overpayments.

Assist with the management of the Prior Authorization process with Network Partners

Participate in the development of the claims organizational structure. Assist with training claims examiners on the unique Surest plan design.

Assist with testing and auditing benefit setup and enhancements in the claims adjudication system.

Perform special projects as defined by Leader.

You’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:

High School Diploma / GED

Must be 18 years of age or older.

3+ years of medical claims processing experience in a health insurance company setting, including fully insured lines of business.

1+ years’ experience with QC/Quantum Choice Platform.

Knowledge and experience in a healthcare environment with HIPAA requirements

Ability to work our normal business hours of 8:00am – 5:00pm, Monday - Friday. It may be necessary, given the business need, to work occasional overtime or weekends.

Preferred Qualifications:

Experience in automating and/or re-engineering manual claim processes

Experience working as a liaison between operational departments and/or technical team.

Previous claims processing experience in Lead or Supervisory level

Claim technology expertise and workflow management including electronic claim files and CARC/RARC mapping.

Proficient in Microsoft Visio, Microsoft Word, Microsoft Excel, and Microsoft PowerPoint

Telecommuting Requirements:

Ability to keep all company sensitive documents secure (if applicable)

Required to have a dedicated work area established that is separated from other living areas and provides information privacy.

Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

Soft Skills:

Quick decision maker

Excellent analytical skills with ability to read and understand complex data and make thoughtful, articulate recommendations; ability to translate analysis of data into meaningful outputs.

Excellent project management skills, with ability to manage multiple priorities with tight deadlines, and demonstrated strong problem-solving skills and attention to detail.

Proven ability to influence course of action when others are directly accountable for outcomes.

Ability to identify key opportunities for action in an innovating environment that includes ambiguity and change.

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington, Rhode Island, OR District of Columbia Residents Only: The salary range for this is $58,300 - $114,300 per year. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.Application Deadline:   This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.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 .#RPO