Provider Relationship Representative

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 and start doing your life’s best work.^SM

You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Role and Job Function Description:

We are in search of a self-directed professional with a strong work ethic and the ability to thrive in high-pressure situations. If you are interested in a position that offers challenging work and a variety of problems to solve and troubleshoot, this might be the right role for you. 

Successful candidates must have an analytical mindset, claims research background, and excellent communication skills.  This role will focus on provider contact rate reduction by analyzing repeat call drivers to identify root cause trends, developing action plans to address trends, and collaborating with internal business partners and providers to implement remediation solutions.

Job Scope and Guidelines 

This role will assist:

• Analyzes and investigates using data (i.e. claim/prior authorization data) to determine call drivers and develop action plans
• Assists in driving process improvement for all lines of business to help reduce provider contact rates
• Coordinate project and process implementation efforts and impact planning with applicable business partners
• Create and maintain applicable project documentation for assigned initiatives including, but not limited to project/task plans, presentations, status reports, meeting minutes, and more
• Determine business and provider needs and collaborate on business processes for Provider Services
• Serve as a key resource on complex and/or critical issues affecting Provider Service Operations
• Obtain, review, and interpret supporting reports and analytics for assigned initiatives
• Strong partnership with business partners across all lines of business on different work group initiatives
• Uses pertinent data and facts to identify and solve a range of problems within area of expertise
• Investigates non-standard requests and problems, with some assistance from others
• Prioritizes and organizes own work to meet deadlines
• Provides explanations and information to others on topics within area of expertise
• Provides explanations and interpretations within area of expertise to internal or external contacts
• Other duties as assigned

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/GED (or higher)
• 1 years of customer service experience with the ability to handle escalated calls, gain the callers trust, take ownership of caller’s issue, and manage through to resolution
• 1 years of knowledge of line of business systems (CSP Facets, COSMOS, UNET) and Provider Service Operations processes (C&S, M&R, E&I)
• 1 years of experience and/or demonstrated understanding/knowledge of physician, ancillary and facility claims, including submission, coding, and processing, contracting methodologies, contract loading, contract interpretation                                     
• 1 years of experience with understanding, interpreting, and determining actionable remediation plans from data driven reporting
• 1 years of experience with educating providers on details of UHG reimbursement policies, etc., and related claim issues 
• 1 years of experience with researching, understanding and communication of UHG’s reimbursement policies 
• Intermediate level of proficiency with PC based software programs and automated database management systems required (Excel and Word – ability to conduct v-lookups, data sorting, filter, pivot tables) 

Preferred Qualifications: 

• 1 years of experience with UHG Technologies  
• Working knowledge of UHG various lines of business 

Soft Skills:

• Excellent communication, time/project management, problem solving, organizational, and analytical skills required, to include a high comfort level with explaining data to internal business partners and the provider community (Required)
• Clear spoken voice and solid communication skills, both verbally and written
• Experience in team interactions and improvement methods/projects
• Ability to work independently and make sound decisions in a fast-paced environment
• Proven ability to manage multiple tasks, prioritize and meet deadlines under a heavy workload
• Excellent follow up, organizational and change management skills
• Ability to systematically analyze problems, draw relevant conclusions and devise appropriate courses of action 

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

California, Colorado, Nevada, Connecticut, New Jersey, Rhode Island, Washington or New York City, NY Residents Only: The hourly range for California, Colorado, Nevada, Connecticut, New Jersey, Rhode Island, Washington or New York City, NY residents is $22.45 to $43.89 hourly. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.

#RPO, #yellow