Senior Provider Relations Representative

2 weeks ago

Flushing, United States UnitedHealthcare Full time
Job Description

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. 

This is an opportunity that's all about where you've been. Your experience. Your potential. Your skills. All pretty solid up to now. It's also an opportunity about what's ahead.  Because on the team at UnitedHealth Group, your potential and your impact can be career changing. We're driving ever higher levels of sophistication in how provider networks are formed and operate. The goal is to improve quality of service while exploring new ways to manage costs. Here's where you come in. You'll use your solid customer service and consultative skills to meet with network providers and help enhance their experience and performance. As you do, you'll discover the resources, backing and opportunities that you'd expect from a Fortune 5 leader. 

Primary Responsibilities:

  • Assist in end-to-end provider claims and help enhance call quality 
  • Use pertinent data and facts to identify and solve a range of problems
  • Investigate non-standard requests and problems
  • Contribute to design and implementation of programs that build/nurture positive relationships between the health plan, providers and practice managers
  • Help implement training and development of external providers through education programs
  • Identify gaps in network composition and services to assist network contracting and development teams

In this role, relationship building, flexibility and reliability will be key. There's a high level of travel within the field to support a particular market of provider groups. You will also be relied upon to provide education and assistance with the implementation of new initiatives. In addition, you will also:

  • Have hands on experience with issues resolution including submitting issues via SharePoint/ applications for contract maintenance update and follow up with provider 
  • Engage provider staff and providers in analysis and evaluation of functional models and process improvements; identify dependencies and priorities
  • Produce, publish and distribute scheduled and ad-hoc client and operational reports relating to the development and performance of products
  • Collaborate with other Physician Business Manager- Area Leads to foster teamwork and build consistency throughout the market
  • Direct and implement strategies relating to the development and management of a provider network, identifying gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs
  • Reviewing the Performance Based Contract data with the office so they understand their performance results Resolving provider complaints which ultimately increase star rating and prospect referrals. 
  • Assist health plan to collect charts regarding HEDIS/STAR measures and Quality Metrics, using standard project methodology (chart retrieval requirements, design, test, etc.)
  • Pull membership report/PCOR star rating reports with score card to assist provider with incentive measurement 
  • Manage the relationship with key Asian medical groups (e.g., CAIPA, Rendr, Excelsior, KAPIPA, SMG, CBWCHC) with high-profile core and strategic provider partners and working weekly with them as SME regarding policies and protocols
  • Serve as a liaison to the health plan and all customers



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:

  • 4+ years of health care/managed care experience
  • 2+ years of provider relations and/or provider network experience
  • Proficient in English/Korean. Will be assessed in the interview process in both languages
  • Proficiency with MS Word, Excel, PowerPoint and Access
  • Intermediate level of proficiency in claims processing and issue resolution
  • Familiarity with Medicare and Medicaid regulations and terminology

New York Residents Only: The hourly range for this role is $28.03 to $54.95 per hour. 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.


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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