Regulatory & Consumer Affairs Advocate - Remote Nationwide

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM


Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

As a member of the Regulatory & Consumer Affairs (RCA) team, this position maintains extensive interaction with UHG senior management, state and federal regulatory agencies, customers, providers, and attorneys regarding complex, high-exposure benefit and coverage issues. This position is responsible for researching, resolving, and preparing a written response which meets regulatory requirements and provides detailed explanations and information to the recipient on extremely complex or multi-issue complaints submitted by consumers and physicians/providers to UHG executives, state attorneys general, departments of insurance and other regulatory agencies, elected officials, and media, among others.

The RCA Advocate also must identify, analyze and remediate process and system defects that drive complaint volumes and drive the necessary corrective action; including leading interactions with state regulatory and compliance leads to oversee multi-departmental initiatives to remediate the identified root cause issues. As such, independent and critical thinking is required to resolve these highly complex, cross-segment issues.

This position coaches and provides feedback to others, both within the RCA team and across the company. The RCA Advocate also acts as a resource for others within the company and department that have less experience or knowledge.

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

Primary Responsibilities:
  • Utilize expert knowledge of claims, benefits, eligibility, reimbursement policies, and compliance requirements to urgently resolve extremely sensitive, complex complaints that have a high level of regulatory, media, and litigation exposure
  • Utilize sound judgment in assessment of each complaint to identify pertinent resolution and analyze case and or claim history to identify root cause, including system and/or process failures
  • Compose clear, concise written responses to complainants, customers, and regulatory agencies describing actions taken to resolve disputed issues and meeting all regulatory requirements while mitigating risk to the Company
  • Engage appropriate business partners to correct any identified system/process failure. Lead project to ensure correction, if necessary
  • Conduct root cause analysis by identifying potential compliance, process or systemic breakdowns; communicate findings to RCA management; and follow through to ensure appropriate actions are being taken to fix root cause across departments
  • Analyze cross-platform, cross-segment data to ensure the accurate determination/resolution of highly complex cases
  • Build, maintain and enhance relationships with our consumers and regulators through consistent provision of accurate, professional, and timely resolution of high profile issues
  • Establish and maintain strong strategic relationships across the company to ensure appropriate resolution of complaint
  • Serve as departmental liaison in with state regulatory and compliance leads for purposes of process improvement projects, CAP reporting, trend analysis, and regulatory concerns
  • Serve as primary resource with Senior Management, plan sponsors, enrollees, and regulatory agencies in resolution of oral and written complaints
  • Provide exceptional service to our enrollees, providers, internal/external and regulatory contacts at all times
  • Lead process RCA internal improvement/root cause analysis projects
  • Anticipates customer needs and proactively develops solutions to meet them
  • Serves as a key resource on complex and/or critical issues
  • Solves complex problems and develops innovative solutions
  • Works with minimal guidance; seeks guidance on only the most complex tasks
  • Translates concepts into practice
  • May lead functional or segment teams or projects
  • Provides explanations and information to others on the most complex issues
  • Coaches, provides feedback, and guides others
  • Acts as a resource for others with less experience

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:
  • Bachelors and/or advanced degree or equivalent experience (including, but not limited to, 2+ years post secondary education; 3+ years Health Plan/Managed Car experience; 4+ years customer service experience; documented experience with professional writing/correspondence in a position in which writing is the primary job duty

Preferred Qualifications:
  • Knowledge of State and Federal Regulations that govern the Appeal process.
  • Strong Claims background
  • Contract/Reimbursement policy experience
  • UHG organizational, system and policy knowledge

Soft Skills:
  • Ability to analyze regulatory statutes to ensure compliance with state laws and ability to respond to regulatory inquiries regarding UHCs compliance with such statutes
  • Demonstrated ability to accurately and with a high degree of quality handle complaints with a high degree of exposure/risk
  • Strong, demonstrated independent and critical thinking skills
  • Demonstrated ability in working effectively with senior level leaders and highly visible customers or regulators
  • Demonstrated leadership skills
  • Project Management skills
  • Knowledge of medical terminology
  • Ability to utilize multiple systems
  • Strong analytical skills
  • Ability to follow a complaint through to resolution
  • Ability to work under time constraints
  • Demonstrated ability to compose professional business letters, including those drafted on behalf of senior level leaders ; including strong presentation skills, oral and written
  • Generally work is self-directed and not prescribed; the RCA Advocate works independently to complete issue research, resolution and response.
  • Works with less structured, more complex issues
  • Sought out as an expert
  • Serves as a leader/mentor to others
  • Ability to manage phone conversation with difficult consumers/providersAbility to learn new systems quickly
  • Attention to details
  • Ability to compose professional business correspondence
  • Excellent organizational skills
  • Excellent interpersonal skills
  • Positive attitude
  • Demonstrable confidence
  • Team player
  • Ability to work independently
  • Ability to make sound decisions in a fast paced environment
  • Quality orientation
  • Ability to transfer knowledge to peers
  • Ability to mentor

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 7 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)

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

Colorado Residents Only: The salary range for Colorado residents is $53,300 to $95,100. 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.

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.

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