Claims Implementation Analyst

4 weeks ago

Eden Prairie, United States UnitedHealth Group Full time

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.

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

Primary Responsibilities:

  • Assesses and interprets customer needs and requirements
  • Solid written and verbal communication skills
  • Makes recommendations and decisions for loading strategy for new market/payor configuration in Facets
  • Creates design documents through the assessment of requirements
  • Identifies opportunities to leverage technology to improve capability performance/impact; Shares learnings with others to facilitate change
  • Demonstrates methods to gather, analyze, implement, test and create implementation documentation solutions
  • Serve as primary subject matter expert to critically assess impact of non-standard implementation requests to claims and payment teams
  • Gather technical requirements and responsible for documentation of business requirements
  • Act as escalation lead for identified risks; work with operational areas to develop and execute risk mitigation plans
  • Drive all components and deliverables throughout the project lifecycle
  • Own project plans that define key tasks and milestones, taking feedback from SMEs and stakeholders. This includes suggested target dates and responsible team(s)/SME(s). Modify plans and customize as needed over time
  • Facilitate and manage mid-size workgroups, enabling a culture of collaboration, trust and disciplined accomplishment of tasks and target dates
  • Assist in preparing materials for presentation to leadership

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:

  • 2+ years of project management experience
  • 2+ years of working within healthcare/payor setting
  • 2+ years of gathering and documenting business requirements, creating and managing project plans, and developing workflows
  • Experience with health plan or claims operations
  • Solid knowledge of business end-to-end processes that impact provider data, pricing, benefit administration and/or claims processing

Preferred Qualifications:

  • Experience with UHC Secondary Platforms (CSP (Community & State) Facets
  • Experience with claims processing or provider billing/back office revenue cycle
  • Experience Medicaid, Medicare, Commercial payment operations
  • Experience with Capitation
  • Experience utilizing Visio and SharePoint

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington, or Washington, D.C. Residents Only: The salary range for this role is $70,200 to $137,800 annually. 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.

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