At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us to start Caring. Conne

Solid understanding of both fully insured and self funded marketplace and pricing disciplines Establish and maintain "strong and appropriate" level relationships with customers and consultants; ensure UHG senior management has customer specific "board level" contacts Develop and monitor client financial performance including renewal planning, negotiation and profitability

Engage members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medicati

This internal customer facing position will work directly with executive level stakeholders within our USP teams to develop advanced UI reporting solutions. This position provides visibility, analytical, ad hoc and development capabilities leveraging data from different functional areas across the USP landscape Working in a matrix environment by partnering with other part

You'll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. At UnitedHealthcare , we're simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow,

Provide day to day paralegal and legal services support including leading or assisting on special projects from the Legal Team Work closely with Legal, Quality Management and Regulatory Affairs (QMRA), Compliance and other cross business and functional stakeholders on activities related to enterprise wide regulatory and quality management systems, including coordination,

Clinical Appeals and Grievances (analyzing, reviewing appeals / grievances) Review of coding edits and reimbursement issues Works with less structured, more complex issues Solves moderately complex problems and / or conducts moderately complex analyses Translates concepts into practice Assesses and interprets customer needs and requirements Identifies solutions to non sta

Take ownership and responsibility for the design and development of all aspects of manual and automated test approach and strategy. Author and execute the Test Suite of manual and automated test scenarios with traceability to requirements to validate the application. Collaborate with business team members to review and clarify requirements and acceptance criteria for all

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us to start Caring. Conne

Manages ongoing relationships and service delivery to clients for one or more accounts Acts as outward facing, dedicated resource for assigned accounts, typically with direct client contact (not call center) and large or complex accounts Works closely with Sales Leads on renewals and upselling, but incumbents do not have specific sales goal accountability or primary respo

Answer incoming phone calls from customers and identify the type of assistance the customer needs (i.e. benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits (EOBs) Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems Own problem t

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, at least restrictive level of care Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact

Determine that the case is assigned to the appropriate team for review (e.g., Medicare, Medicaid, Commercial) Validate that cases/requests for services require additional research Identify and utilize appropriate resources to conduct non clinical research (e.g., benefit documents, evidence of coverage, state/federal mandates, online resources) Prioritize cases based on ap

Lead projects engaging business teams up through the COO level and external government contacts and vendors Facilitate and contribute to the development of program or project scope statements with applicable stakeholders (e.g., program/project charter, Statement of Work, Business Vision Document) Lead and coordinate projects that span multi departmental and cross function

Interpret and analyze claims, capitation, membership data, and recommend best approaches in support of underwriting, actuarial and utilization analyses Lead projects to completion by contributing to database creation, statistical modeling and financial reports Performs complex data validation and conceptual analyses. Create and update automated processes within client dat