Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)The Senior Network Program Specialist is responsible for the successful program design, implementation and support of Non Network Affordability initiatives. These initiatives include but are not limited to Extended Non Network Rate Program, Maximum Non Network Rate Program, Pay the Enrollee, Shared Savings and Facility R&C. Senior Network Program Specialists may perform Non-network spend analysis, develop strategies and implement process and cost savings initiatives; obtain data, verify validity of data, and analyze data as required. Other responsibilities may include inventory reporting, system problem investigation, reviewing and analyzing system impacts, making recommendations for process improvements, including policy and procedure updates, giving presentations and monitoring vendor file issues.Primary Responsibilities:Assess and interpret customer needs and requirementsIdentify solutions to non – standard requests and problemsSolve moderately complex problems and / or conduct moderately complex analysesWork with minimal guidance; seek guidance on only the most complex tasksTranslate concepts into practiceProvide explanations and information to others on difficult issuesCoach, provide feedback, and guide others Act as a resource for others with less experience
Required Qualification:Undergraduate degree or equivalent work experience5+ years of experience with claims processing, resolution or quality review on UNET2+ years with ORS and ORS routingIntermediate proficiency in MS Word and ExcelExcellent written and verbal communication skillsAbility to analyze large amounts of data to determine root causeAbility to convey complex information to others and make it more easily understoodAbility to prioritize multiple tasks in an environment of rapid changePreferred Qualifications: Project management experienceAdvanced proficiency in ExcelExperience with the SOS processWebstrat application experienceExperience with Smart Audit Master / SAM EditsPrevious exposure to P&P WritingExperience with CRT Project submissionExperience performing UNET claim adjustmentsCareers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SM 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. Job Keywords: External audit specialist, claim investigator, claims adjustor, Claims SME, transaction analyst, QA, Sacramento CA, Los Angeles, CA, California, Seattle, WA, Washington, Denver, CO, Colorado, Phoenix, AZ, Arizona, Portland, OR, Oregon
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.