Senior Provider Relations Representative - Claims Analysis and Research
UnitedHealth Group - Oldsmar, FL

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Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)

The Senior Provider Relations Representative is responsible for assisting in the full range of provider relations and service interactions within UnitedHealth Group, including working on end-to-end provider claim and call quality, ease of use of physician portal and future service enhancements, and training & development of external provider education programs. Senior Provider Relations Representatives assist in the design and implementation programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. Other responsibilities include supporting those who direct and implement strategies relating to the development and management of a provider network, identify gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs, and may also be involved in identifying and remediating operational short-falls and researching and remediating claims.

In this role you will be expected to:
- Use pertinent data and facts to identify and solve a range of problems.
- Investigate non-standard requests and problems, with some assistance from others.
- Prioritize and organize own work to meet deadlines.
- Provide explanations and information to others on topics within area of expertise.
- Would prefer to have Undergraduate degree strongly preferred

Positions in this function are accountable for the full range of provider relations and service interactions within UHG, including working on end-to-end provider claim and call quality, ease of use of physician portal and future service enhancements, and training & development of external provider education programs. Designs and implements programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. Directs and implements strategies relating to the development and management of a provider network. Identifies gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs. May also be involved in identifying and remediating operational short-falls and researching and remediating claims.
- Analyzes and investigates.
- Provides explanations and interpretations within area of expertise.

Requirements Requirements: .
- Undergraduate degree preferred.
- 2+ years of managed care or medical insurance experience.
- 2 + years of experience in a claims, customer service or provider support role is preferred.
- Proven ability to uncover and resolve problems and troubleshoot claim issues.
- Experience resolving root cause of claim problems.
- Proven track record in facilitating correction of system and process failures.
- Ability to investigate complex problems with minimal direction.
- Experience in analyzing data and uncovering trends in order to implement permanent solutions.
- Ability to make ethical decisions based on regulations and policy when solving claim problems.
- Ability to retain information and apply it appropriately when investigating claim issues.
- Ability to manage internal organizational relationships that will drive change to prevent reoccurrence of claim problems.
- Ability to communicate clearly and with confidence with employees at all levels including management.
- Able to communicate findings from research and resolution in a clear and concise way for the customer.
- Good organization, planning and time management skills.
- Basic level of proficiency with MS Excel and Word.

OptumHealth is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.

OptumHealth 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 health care 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.

At OptumHealth, you will perform within an innovative culture that's focused on transformational change in the health care system. You will leverage your skills across a diverse and multi-faceted business. And you will make contributions that will have an impact that's greater than you've ever imagined.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V.

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