21 days old

Claims Process Implementation Architect - Telecommute - 917099

Eden Prairie, MN 55344 Work Remotely
  • Job Code
    917099

Combine two of the fastest-growing fields on the planet with culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry thats improving the lives of millions. Here, innovation isnt about another gadget, its about making health care data available wherever and whenever people need it, safely and reliable. Theres no room for error. Join us and start doing your lifes best work. (sm)

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

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Primary Responsibilities:

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  • Acts as the subject matter expert representing the business with the ability to clarify requirements, prioritize work, and drive requirements to acceptance thru the software development lifecycle
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  • Serves as the primary liaison between business and technical team, responsible for gathering, documenting, and prioritizing business requirements in support of critical needs
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  • Act as a recognized voice of the customer to the team, on behalf of the business
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  • Translates business requirements into features and the development of user stories
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  • Define and document acceptance criteria for features/user stories
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  • Works closely with the OCSP Team to represent capabilities and features at team level
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  • Participates in solution analysis and design meetings
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  • Participates in discussions to document Current State/Future State workflows as needed
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  • Reviews test cases against acceptance criteria
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  • Self-motivated and able to work with little direct supervision and drive results with disciplined follow-though
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  • Strong strategic thinking and business acumen with the ability to align people related strategies and recommendations with business objectives
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  • Experience driving decision-making with teams and management
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  • Experience working with cross-functional teams
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  • Ability to effectively break down barriers to maintain progress on deliverables
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  • Diplomatic with effective negotiation and conflict resolution skills
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  • Ability to make quick decisions when clarification or modification is needed
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  • Self-directed and able to drive deliverables to completion with minimal oversight
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  • Detail oriented and obsessively organized
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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.

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Required Qualifications:

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  • Undergraduate degree or High School Diploma/GED and four additional years of experience as stated in the minimum qualifications
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  • 5+ years of experience working in or with Claims or Prior Authorization / Medical Management function at a Health plan or care delivery organization
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  • 3+ years of experience in working knowledge of referral, prior authorization and utilization management functions, including working knowledge of applicable health care regulations at a health plan
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  • 3+ years of experience working with Claims processes such as encounters, claims management, reporting, delegated audits processing, Electronic Fund Transaction / Electronic Remittance Advice
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  • Prior experience as a liaison between business and technical team, responsible for gathering, documenting, and prioritizing business requirements in support of critical needs
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  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained.
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Preferred Qualifications:

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  • Product Owner/Manager or Business Analysis experience
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  • Knowledge of Facets platform
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  • Knowledge of HIPPA transaction codes
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  • Knowledge of Medical Management Platforms such as CareAdvance, Jiva, Tapestry
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  • Knowledge of Medicaid/Medicare
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  • Claims processing skills
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Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

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*All Telecommuters will be required to adhere to UnitedHealth Groups Telecommuter Policy.

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Colorado Residents Only: The salary range for Colorado residents is $79,700 to $142,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary, UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

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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.

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UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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Job Keywords: Claims; projects; health plan, telecommute, telecommuter, telecommuting, work from home, work at home, remote

Categories

Posted: 2021-03-22 Expires: 2021-04-21

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Claims Process Implementation Architect - Telecommute - 917099

UnitedHealth Group
Eden Prairie, MN 55344

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