Claims Business Process Consultant - National remote

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Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

Energize your career with one of Healthcare’s fastest growing companies. You dream of a great career with a great company – where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.

This opportunity is with one of our most exciting business areas: Optum – a growing part of our family of companies that make UnitedHealth Group a Fortune 5 leader.

Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.

This position is full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am - 7:00pm local time (any time zone). It may be necessary, given the business need, to work occasional overtime.

We offer weeks of on-the-job training. The hours during training will be 7:00am - 7:00pm local time. Training will be conducted virtually from your home.

We offer weeks of on-the-job training. The hours of the training will be aligned with your schedule.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities

• Work independently while meeting appropriate deadlines consistently
• Work with minimal guidance; seeks guidance on complex tasks
• Act as a resource for others– primarily within the department, but also representing Behavioral Health Claim Operations across the enterprise
• Outbound calls to providers
• Coordinate own activities, work is self -directed and not prescribed
• Plan, prioritize, organize, and complete work to meet established objectives
• Identify and resolve claim basic operational problems using defined processes, expertise, and judgment
• Investigate claim issues as identified and communicate resolution to internal customers
• Identify root cause of issues
• Development and documentation processes for accurate and efficient claim payment
• Anticipate customer needs and proactively identifies solutions
• Call upon others for assistance outside scope and with large, complex issues
• Refer misdirected issues to non-claim teams
• Provide expertise and customer service support to internal customers
• Communicate research findings to applicable stakeholders
• Review assigned CPEWS, Adjustment Trends, Denial Trends alerts in an accurate and timely manner and acting as appropriate
• Apply knowledge / skills to identify and remediate straightforward claim issues
• Other duties as assigned
  
  

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 OR equivalent work experience
• Must be 18 years of age OR older
• 4 years of experience analyzing and solving customer problems, using the telephone and computer as the primary instruments to perform job duties
• Experience working with claims
• Moderate Proficiency with computer and Windows computer applications, which includes the ability to learn new and complex computer system applications
• Ability to work any of our 8-hour shift schedules during our normal business hours of 7:00am - 7:00pm local time (any time zone), including the flexibility to work occasional overtime, based on the business need
  
  

Preferred Qualification

• Experience with COSMOS, UNET, and/or OBH FACETS
  
  

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

• Ability to multi - task, this includes ability to understand multiple products and multiple levels of benefits within each product
• UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status
• All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
  
  

The hourly range for this role is $23.70 to $46.35 per hour based on full-time employment. 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: T his 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 .

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