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.
There are changes happening in health care that go beyond the basics we hear in the news. People like you and organizations like UnitedHealth Group are 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 orientation and knowledge of insurance claims to serve as an advocate for providers in our networks. As you do, you'll discover the impact you want and the resources, backing and opportunities that you'd expect from a Fortune 5 leader.
In this role, you'll be part of a performance driven, fast paced organization that is serving multiple markets. You'll have frequent interactions with those who provide mental healthcare in your role as the liaison between Optum and the provider community.
Positions in this function are accountable for the full range of provider relations and service interactions within Optum and UHC, including working on end-to-end provider claim and call quality, ease of use of the provider portal and future service enhancements, and foster communication of external provider education programs. Designs and implements programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. Directs and implements strategies relating to the development and management of a provider network. Identifies gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs. May also be involved in identifying and remediating operational short-falls and researching and remediating claims- Generally work is self-directed and not prescribed.
If you are located in Florida, you will have the flexibility to work remotely* as you take on some tough challenges
Primary Responsibilities:
- Assist in end-to-end provider claims and help enhance call quality
- Coach, provide feedback and guide others
- Assist in efforts to enhance ease of use of physician portal and future services enhancements
- 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
- Works with less structured, more complex issues
- Serves as a resource to others
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:
- High school diploma or equivalent experience
- 5+ years of health care/managed care experience
- 3+ years of provider relations and/or provider network experience
- 1+ years of experience with Medicare and Medicaid regulations
- Intermediate level of proficiency in claims processing and issue resolution
- Proficiency with MS Word, Excel, PowerPoint
- Ability to travel up to 25% if needed
Preferred Qualifications:
- Behavioral Health Experience
- Spanish speaking
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
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.
