1+ months

***Senior Consultant, Health Plan / Payer Operations - Telecommute

Minnetonka, MN 55345
  • Job Code
    821094
As a Senior Consultant you'll provide consulting services to strengthen and improve health care operations that result in stronger financial returns and a healthier health care system. You'll use your strong strategic and business acumen to work closely with clients to define, develop and document business requirements to ensure needs are captured and critical deliveries are executed. This consulting career gives you the opportunity to travel and share in a mission that inspires. You'll see your ideas come to life and your achievements recognized. You won't find tougher challenges. And you won't find smarter people working together to solve them. Join us and start doing your life's best work.(sm)
 

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

 
Primary Responsibilities:
 
We are seeking candidates who have health plan operations experience and previous management consulting experience in one or more of the following areas of Health Plan Operations:
  • Health Plan Operations
    • Core Administration: Health plan operational departments and their primary and cross-departmental functions and operations (aka: health plan value chain), administrative cost containment, regulatory requirements and compliance, health plan product types (fully insured, self-insured, managed care, HMO, PPO)
    • Lines of Business: Commercial, ACO, Managed Medicaid, Medicare Advantage
    • Health care and health insurance markets and driver
  • Health Plan Management Consulting
    • Process Improvement: process management and improvement, root cause analysis, problem solving, policies and procedures, desk-level procedures, training
    • Business Analysis: business requirements development, business analysis, gap identification, process and work flows design
    • Project Coordination / Management: documentation, meeting facilitation, project planning
    • Data Management: data analysis and financial analysis
    • Client relationship development and management
    • Business development and revenue growth
  • Domain expertise and previous management consulting experience in one or more of the following additional areas:
  • Claims Processing
    • Claims adjudication / processing activities for a core claims administrative system (Facets, QNXT, HealthRules, Ika, etc.)
    • Clinical editing systems (ClaimCheck, CES) configuration and operations
    • Claims reimbursement analysis
    • Claims research and adjustment
    • Claims Third Party Liability and subrogation processing
    • Claims system configuration: processing rules, edits and pends
    • Other health plan operations impacts on claims: provider contracting, referrals and authorizations, benefit plan design and configuration
  • Call Center
    • Member, Provider and Claims call center operations core administrative systems for call management, scheduling, CRM, IVR
    • Appeals and Grievance processes
  • Provider / Network
    • Provider contracting, provider relations and network development operations in a health plan
    • Provider portals
  • Enrollment / Billing
    • Member enrollment, premium billing
    • Member portals
  • Clinical
    • Medical cost containment, medical policy
    • clinical business processes
    • Utilization management, disease management, case management
    • EMR
  • Payment Integrity
    • Claims Editing
    • Enrollment Integrity/Coordination of Benefits
    • FWA
    • Overpayment Identification
    • Claims auditing
    • Health care Subrogation / Third Party Liability
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Categories

Posted: 2019-05-08 Expires: 2019-09-20

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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***Senior Consultant, Health Plan / Payer Operations - Telecommute

UnitedHealth Group
Minnetonka, MN 55345

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