Benefit Implementation Lead

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:

  • Creates complex design documents through the assessment of requirements. Assesses alternatives to different designs and chooses best solution to fit business needs
  • Perform oversight of configuration on new client implementations and act as configuration lead
  • Conducts analysis, configures, tests and creates configuration documentation solutions for all applications in the Facets system
  • Provides technical assistance/mentoring to other configuration analysts
  • Serve as primary Configuration subject matter expert to critically assess market and payor contracts, DOFR (Division of Financial Responsibility) documents, EOC'S (Evidence of Coverage) , etc., to ensure Facets system functionality can meet benefit and group services requirements; and recommend solutions to minimize manual processes to address system limitations
  • Gather technical requirements and participate in the documentation of business requirements to create automation to improve standards in configuration operations
  • Act as escalate lead for identified risks; work with operational areas to develop and execute risk mitigation plans
  • Prepare materials and present to leadership team

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:

  • 3+ years of Facets Configuration experience with benefit configuration
  • 3+ years of experience with group structure and/or eligibility configuration
  • 3+ years of working with Medicare, Medicaid or Commercial products
  • Experience gathering and documenting business requirements
  • Solid knowledge of business end-to-end processes that impact benefit administration and claims processing
  • Proven ability to interpret benefit requirements and drive benefit structure to apply network requirements

Preferred Qualifications:

  • Experience with health plan delegation and operations
  • Experience with UHC Secondary Platforms (CSP (Community & State) Facets / COSMOS (Claims Platform)
  • Experience executing SQL queries and analyzing reports

*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, Washington, D.C. Residents Only: The salary range for this role is $88,000 to $173,200 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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