Senior Claims Business Processing Consultant - Remote - 2005714

UnitedHealth Group

Hartford Connecticut

United States

Executive Management
(No Timezone Provided)

You’ll enjoy the flexibility to telecommute* from anywhere within the

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.SM

Our claims operations, including our Senior Claims Business Process Consultants, are the focal point of handling information about services patients receive and the way those services get paid. It's complex, detailed work. It's fast paced challenge. It's a job that calls on you to be thoughtful, resourceful, team-driven and customer-focused. To put it mildly, there is never a dull moment.

This position is full-time (40 hours/week) Monday – Friday. Employees are required to work our normal business hours of 8:00am – 5:00pm.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

  • Implement claim payment processes that meet regulatory requirements and claim business rules.
  • Conduct claims systems utilization, capacity analysis/planning and reporting, and claims-related business and systems analysis.
  • Ensure data integrity, data security and process optimization.
  • Serve as our internal Regulatory Affairs' point of contact
  • Partner with functional area leaders and SMEs to determine impact and solutions
  • Implement Claim ops solutions to meet regulatory requirements
  • Lead Claim Ops market conduct or financial exam activity, corrective action plans responses and restitution projects
  • Remediate gaps in existing production processes that do not meet regulatory requirements

    • 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:

  • Associate degree or High School Diploma/GED with 4+ years health plan experience in claims, contracting, or reimbursement.
  • 4+ years of experience with clinical editing tools () in support of facility or physician reimbursement
  • 2+ years of experience working independently in a remote environment.
  • Experience with presentations and facilitating virtual meetings
  • Experience in Microsoft Office (Excel, Word, PowerPoint). Candidate will have the ability to sort data, formulas, pivot tables, document tracking, presentation creation.
  • Candidate will have the ability to sort data, formulas, pivot tables, document tracking, presentation creation, note taking and sharing.
  • Coding or clinical certification, CPC, COC, CIC, CRC, CASCC, CANPC, CCC, CCA, CPDC, CEDC, CEMC, CFPC, CGIC, CIMC, CGSC, CHONC, CIRCC, COBGC, COPC, COSC, CPEDC, CRHC, CUC, CCS, RN, BSN, AND, MA, LPN, PT, PTA

    • Preferred Qualifications:

  • Project Management and ability to manage multiple projects concurrently.
  • Knowledge of provider contracting
  • Experience in one or more of the following platforms/applications – UNET/TOPS, FACETS, ppoONE, COSMOS, NICE or CIRRUS.
  • Experience with physician and/or facility reimbursement policy and coding methodologies (CPT, HCPCS, ICD-10)

    • Telecommuting Requirements:

  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
  • Ability to keep all company sensitive documents secure (if applicable)
  • 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:

  • Exceptional organizational skills. Ability to prioritize daily work.
  • Excellent verbal and written with the ability to clearly articulate information in a clear and concise manner.
  • Ability to effectively collaborate with a variety of cross functional teams, and able to create strong working relationships with both technical and business partners

    • UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

    Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at Opens in a new window

    Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. Opens in a new window

    Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 10 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 wherever 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

    Colorado Residents Only: The salary range for Colorado residents is $64,800 to $116,000. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

    Senior Claims Business Processing Consultant - Remote - 2005714

    UnitedHealth Group

    Hartford Connecticut

    United States

    Executive Management

    (No Timezone Provided)

    You’ll enjoy the flexibility to telecommute* from anywhere within the

    Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.SM

    Our claims operations, including our Senior Claims Business Process Consultants, are the focal point of handling information about services patients receive and the way those services get paid. It's complex, detailed work. It's fast paced challenge. It's a job that calls on you to be thoughtful, resourceful, team-driven and customer-focused. To put it mildly, there is never a dull moment.

    This position is full-time (40 hours/week) Monday – Friday. Employees are required to work our normal business hours of 8:00am – 5:00pm.

    *All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

    Primary Responsibilities:

  • Implement claim payment processes that meet regulatory requirements and claim business rules.
  • Conduct claims systems utilization, capacity analysis/planning and reporting, and claims-related business and systems analysis.
  • Ensure data integrity, data security and process optimization.
  • Serve as our internal Regulatory Affairs' point of contact
  • Partner with functional area leaders and SMEs to determine impact and solutions
  • Implement Claim ops solutions to meet regulatory requirements
  • Lead Claim Ops market conduct or financial exam activity, corrective action plans responses and restitution projects
  • Remediate gaps in existing production processes that do not meet regulatory requirements

    • 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:

  • Associate degree or High School Diploma/GED with 4+ years health plan experience in claims, contracting, or reimbursement.
  • 4+ years of experience with clinical editing tools () in support of facility or physician reimbursement
  • 2+ years of experience working independently in a remote environment.
  • Experience with presentations and facilitating virtual meetings
  • Experience in Microsoft Office (Excel, Word, PowerPoint). Candidate will have the ability to sort data, formulas, pivot tables, document tracking, presentation creation.
  • Candidate will have the ability to sort data, formulas, pivot tables, document tracking, presentation creation, note taking and sharing.
  • Coding or clinical certification, CPC, COC, CIC, CRC, CASCC, CANPC, CCC, CCA, CPDC, CEDC, CEMC, CFPC, CGIC, CIMC, CGSC, CHONC, CIRCC, COBGC, COPC, COSC, CPEDC, CRHC, CUC, CCS, RN, BSN, AND, MA, LPN, PT, PTA

    • Preferred Qualifications:

  • Project Management and ability to manage multiple projects concurrently.
  • Knowledge of provider contracting
  • Experience in one or more of the following platforms/applications – UNET/TOPS, FACETS, ppoONE, COSMOS, NICE or CIRRUS.
  • Experience with physician and/or facility reimbursement policy and coding methodologies (CPT, HCPCS, ICD-10)

    • Telecommuting Requirements:

  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
  • Ability to keep all company sensitive documents secure (if applicable)
  • 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:

  • Exceptional organizational skills. Ability to prioritize daily work.
  • Excellent verbal and written with the ability to clearly articulate information in a clear and concise manner.
  • Ability to effectively collaborate with a variety of cross functional teams, and able to create strong working relationships with both technical and business partners

    • UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

    Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at Opens in a new window

    Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. Opens in a new window

    Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 10 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 wherever 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

    Colorado Residents Only: The salary range for Colorado residents is $64,800 to $116,000. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

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