Senior Claims Business Process Consultant - 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.

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work. SM

Our claims operations, including our Senior Claims Business Process Consultants, are the focal point of handling information about services patients receive and the 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.

This position will work enterprise wide with internal business partners to facilitate the review and assessment of medical groups (MG), independent physician associates (IPA), hospitals, and ancillary providers seeking to enter into value-based contracting that may also include delegation of activities that are otherwise United Healthcare's responsibility. This position will collaborate with other business partners to ensure these entities are operationally and financially sound and that internally we at UHC are operationally ready where delegation oversight is being assigned. In addition, this position will guide network management as to the requirements for entrance into value based and delegated arrangements.

This will support a key UHG strategy to increase the membership associated with value-based contracts with aligned provider incentives. This position will utilize their project management and analytical skills, as well as extensive knowledge of the business and the business processes to facilitate these operational evaluation processes. This position requires the ability to act independently, to lead and diagnose process improvement opportunities, as well as the ability to drive complex issues to resolution with minimal supervision.

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). It may be necessary, given the business need, to work occasional overtime.

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

Primary Responsibilities:
  • Facilitate the end-to-end value-based contracting and delegation review process for assigned proposals. Work enterprise wide with UHN, M&R, C&S and E&I LOB and Health Plan leaders to ensure compliance with the Provider Risk Based Contracting and/or Delegation Review process and timely and accurate submissions.
  • Develop and implement improvements to the PBR process to ensure that the appropriate and relevant metrics and materials are presented to the Delegation Oversight Committee for approval.
  • Apply analytical and professional judgement to appropriately guide and resolve Network Management inquiries and issues. Articulate to proposal requestors the bottom line on the complexity of the requested contracts and services.
  • Be proactive in identifying high-risk issues and effectively communicate the issues, including any barriers or risks to their resolution, with both internal and external parties. Such communication may be written or verbal.
  • Remove any roadblocks that do not support "speed to market" for these risk-based contract proposals.
  • Provide appropriate subject matter expertise and business analysis for proposals. This includes driving to the right provider solution to ensure we offer what we can support, and we can support what we offer in value-based contracting.
  • Ensure all compliance metrics for federal, state, NCQA and URAC are being met and there is appropriate oversight of the activities being assigned to the appropriate delegation oversight team
  • Achieve operational metrics measuring the effectiveness and efficiency of the PBR process.
  • Support the implementation of standard operational processes for the value-based membership across all platforms.
  • Promote and support the training and education of the Provider Risk Based Contracting and Delegation process across the various business stakeholders.
  • Address any missing or need for updates to the value based contracting language/delegation grid exhibit and/or provider administration guide.

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:
  • Bachelor's degree(or higher) OR High School Diploma / GED with equivalent experience
  • 3+ years of experience developing and implementing business process change initiatives, including documentation
  • 3+ years of experience in communication, internal and external executive level
  • Intermediate proficiency with Microsoft office, including Word and Excel, (Create, Edit, Pivot, formulas, vLookup, run reports).

Preferred Qualifications
  • Knowledge of Value Based Contracting or Capitated Delegated Division of Responsibility business models
  • Experience in the Health Care industry
  • Project management experience
  • Experience performing financial analysis.

Soft Skills:
  • High proficiency in analytical skills
  • Intellectually curious
  • Bias for action
  • High proficiency in leading/driving meetings and conversations
  • High proficiency with relationship skills
  • Experience with process improvement, workflow, benchmarking and / or evaluation of business processes
  • Change Management experience

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

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 UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 5 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 wherever 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

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $64,800 to $116,000. The salary range for Connecticut / Nevada residents is $71,400 to $127,400. 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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