Claims Business Process Consultant - Behavioral Health - Remote

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

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

Energize your career with one of Healthcare's fastest growing companies.

You dream of a great career with a great company - where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it's a dream that definitely can come true. Already one of the world's leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.

This opportunity is with one of our most exciting business areas: Optum - a growing part of our family of companies that make UnitedHealth Group a Fortune 10 leader.

Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.

Flexible, Friendly, Fast on your feet, that's a great start. Accurate, Accountable, Self-Directed; These traits can take you places. Our claims operations are the focal point of handling information about services patients receive and they way those services get paid. It's complex, detailed work. It's fast paced challenge. It's a job that calls on you to be thoughtful, resourceful, team-driven and customer-focused. To put it mildly, there is never a dull moment. Senior Claims Business Process Analysts are responsible for all related aspects of claim system processes and claim business rules. Include claims systems utilization, capacity analyses/planning and reporting, claims-related business and systems analysis. Ensure data integrity, data security and process optimization.

This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of (8:00am - 5:00pm EST). It may be necessary, given the business need, to work occasional overtime. This position is remote in the US.

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

Primary Responsibilities:
  • Work independently while meeting appropriate deadlines consistently
  • Work with minimal guidance; seeks guidance on complex tasks
  • Act as a resource for others- primarily within the department, but also representing Behavioral Health Claim Operations across the enterprise
  • Coordinate own activities, work is self -directed and not prescribed
  • Plan, prioritize, organize and complete work to meet established objectives
  • Identify and resolve complex operational problems using defined processes, expertise and judgment
  • Investigate claim issues as identified and communicate resolution to customers
  • Identify root cause of issues
  • Development and documentation of processes for accurate and efficient claim issue research and claim payment
  • Apply knowledge / skills to identify and remediate complex claim issues
  • Anticipate customer needs and proactively identifies solutions
  • Collaborate with teammates to accept transfer of large, complex issues
  • Recommend remediation steps for non-claim root causes
  • Influence business partners to adopt recommended remediation steps for non-claim root causes
  • Serve as the liaison to a complex customer base to manage response and resolution of escalated issues with external and internal customers
  • Communicate research findings to applicable stakeholders
  • Review assigned CPEWS, Adjustment Trends, Denial Trends alerts in an accurate and timely manner and acting as appropriate
  • Analyze claim performance to identify relevant patterns/trends, and communicate to applicable stakeholders (e.g., leadership reports, quality dashboards)
  • Document processes and best practices of the team
  • Provide feedback to team members regarding improvement opportunities
  • Lead cross-functional projects and discussions to remediate issues impacting accurate and efficient claim payment
  • Serve on applicable cross-organizational committees/work groups to identify/ communicate common claims quality issues, trends and patterns
  • Identify, communicate, and implement opportunities for improving Claim processes
  • Train and mentor team members
  • Proactively identifies new solutions to problems
  • 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)
  • 2 years claims experience in CSP Facets
  • 2-3 years of experience as a Claim SME, Provider Operations SME or equivalent experience
  • Intermediate knowledge Microsoft Office
    • Word (create and edit correspondence)
    • Excel (ability to create, edit, and sort spreadsheets, basic analytical formulas (vlookup, if))
    • Outlook (email and calendar management)
    • PowerPoint (ability to create and edit slides)
  • 1+ years of experience in the healthcare industry, specifically in the following areas; billing practices, terminology, legal/regulatory requirements, coding standards, and/or healthcare reform

Preferred Qualifications:
  • Identify and interpret applicable provider contract information (e.g., in-network vs. out-of-network, contracted rates, shared savings)
  • Working knowledge of how to utilize and navigate applicable claims processing systems, platforms and databases (e.g., UNET, COSMOS, CSP Facets, OBH Facets, NDB)

Telecommuting Requirements:
  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
  • Ability to keep all company sensitive documents secure (if applicable)
  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Soft Skills:
  • Ability to work with ambiguous regulation and make decisions based on needs
  • Collaboration
  • Support core values within the team/organization
  • Support team engagement initiatives
  • Attention to detail
  • Organizational skills
  • Problem solving skills
  • Effective communication skills (verbal and written)
  • Ability to work independently and make sound decisions in a fast-paced environment

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible.

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $53,300 - $95,100. The salary range for Connecticut / Nevada residents is $58,800 - $104,600. 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

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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