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The health care system is still evolving at a rapid pace. Technology is driving new advances in how patient care is delivered and how it’s reimbursed. Now, UnitedHealth Group invites you to help us build a more accurate and precise approach to claims adjudication. In this role, you’ll be responsible to support and improve First Service Accuracy and overall quality within UNET E&I Single Adjustment Claim Operations. Improve overall constituent satisfaction through improved claim handling, reviewing external audit scores, decreasing performance guarantee pay outs and implement strong remediation efforts to prevent future defects through root cause analysis, supported by First Service Accuracy data and other quality measures.
This position is full-time (40 hours/week) Monday – Friday. 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). It may be necessary, given the business need, to work occasional overtime.
This is a challenging role with serious impact. You’ll be providing a senior level of support and subject matter expertise within a fast paced, intense and high volume claims operation where accuracy and quality are essential.
Training will be conducted virtually from your home.
What we do defines who we are. Take a deeper look at how we’re providing support during this global health crisis and search for a way you can get involved. View our Covid-19 Resources Page at:
* Partner with various departments to perform root cause analysis and support remediation activities.
* Coordinate remediation efforts with business partners (Account Manager Team, SAM Edit Rule, Process Enablement, SOS) to mitigate rework opportunities within COBI Claim Operations.
* Support end to end policy level analysis to identify areas of opportunity (i.e. increase auto adjudication; confirm accuracy of claim processing, remove upstream roadblocks, improve customer experience, etc.)
* Examine historical First Service Accuracy results/findings to determine overall impact on monthly First Service Accuracy fallout to determine opportunities for enhancement. Compare findings with internal Performance Guarantees, High Dollar reviews, and RT CEAP Data for remediation.
* Identify, trend, and quantify FSA opportunities at processor, provider, and policy level.
* Act as lead project manager of identified opportunities throughout project and reporting period.
* Plan, execute and drive root cause remediation (e.g. Case Install, Macros, System Enhancements, Quality FIT Tips, SAM Edits, Brainshark communication, etc.)
* Track month over month First Service Accuracy opportunities to mitigate rework with notable metric improvements.
* Participate and present in regular meetings with leadership, including direct team alignment, and COBI Senior Leadership.
* Provide weekly/monthly quality reports to leadership outlining top defects impacting office level results, processor results, and performance guarantee results.
* Work with leadership team to drive improvement First Service Accuracy metric scores at team and COBI level.
* Work with Internal Quality Team to prioritize First Service Accuracy opportunities that impact various COBI teams.
* Partner with External Audit Remediation Analytical Specialists to review audit findings on manual adjudication defects, conduct root cause analysis and confirm remediation provided to processor/processing teams.
* Participate in External Audit response as requested.
* Provide impact results on discovered and implemented First Service Accuracy opportunities.
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.
* High School Diploma / GED (or higher) or equivalent work experience
* 2+ years of experience analyzing and solving customer problems in an office setting
* Moderate proficiency with computer and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
* Intermediate level of Microsoft Excel (data entry, sorting / filtering, pivot tables)
* Intermediate level of Microsoft PowerPoint (create and edit presentations)
* Must live in a location that can receive a UnitedHealth Group approved high – speed internet connection or leverage an existing high – speed internet service
* Associate’s Degree (or higher)
* 3+ year’s UNET adjustment processing experience
* 2+ years of experience working within project teams on quality improvement methods, innovation implementation ideas; projects planning
* DDE / STARS / ATS Claim processing experience
* DDE Case processing experience
* Proven experience in creating Microsoft PowerPoint presentations
* Proven Leadership Ability
* Working knowledge of FSA, SAM, Smart Audit Master, Sam Edit Rules, Macros and System Limitations
* Ability to multi – task, this includes the ability to understand multiple products and multiple levels of benefits within each product
* Presentation experience in well – honed public speaking to support findings to tailored audience
UnitedHealth Group is an essential business. The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us.
Some of the steps we’ve taken to ensure employee well-being include:
* Launched our ProtectWell app and UnitedCARES program to help ease the burden and stress for our UnitedHealth Group team members and their immediate family affected by COVID-19
* Daily updates from our CEO Dave Wichmann to support and inspire team members during this challenging time
* Onsite social distancing and increased sanitization measures for employees who have been welcomed back to our offices
* Fully cover the COVID-19 healthcare costs for our employees
You can learn more about all we are doing to fight COVID-19 and support impacted communities at:
UnitedHealth Group is a team of more than 260,000 people who are building career success through commitment, compassion and a desire to make a difference. Join us. Learn more about how you can start doing your life’s best work.SM
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.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.
Keywords: Healthcare, health care, Managed Care, Claims, Customer Service, Claims Quality, hiring immediately
To Apply: https://www.jobg8.com/ATSApply.aspx?YoougGHUlIBA8KZv3K3nJAn