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Senior Claims Business Process Consultant - Work from Home

Company: UnitedHealth Group
Location: Biloxi
Posted on: June 19, 2022

Job Description:

If you are located within the state of Mississippi, you will have the flexibility to telecommute* (work from home) 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.
The Community & State Encounter Program Management team has oversight of complete, timely and accurate encounter (claim) submissions to state customers. This includes working with health plans and states on process improvements, implementing new requirements and analyzing current production results. A Medicaid Encounter Senior Claims Business Process Consultant is a Subject Matter Expert (SME) for one or more states, responsible for establishing a thorough understanding of state encounter requirements and meeting or exceeding those encounter requirements and internal goals by correcting encounters with issues in order to get them accepted by our state customers.


This position is full-time. Employees are required to work our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime or weekends.


  • All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
    Primary Responsibilities:

    • Perform end-to-end encounter business process activities, which include:

      • Gathering and understanding state requirements and translating these into business processes

      • Identifying opportunities to resolve encounter error root causes using an understanding of upstream and downstream impacts

      • Participating in the creation, control, and improvement of business processes



      • Correct encounter bypasses and rejects; includes managing encounter corrections with the Information Technology (IT) team

      • Produce monthly reporting of status against goals

      • Develop collaborative relationships with internal partners impacting encounters

      • Develop relationships with state partners in order to research issues

      • Host or participate in regular meetings with health plans to share encounter status and address issues
        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.
        Requirements Qualifications:

        • High School Diploma/GED (or higher)

        • 2+ years of experience in data analysis

        • 2+ years of experience in business and/or finance analysis

        • 2+ years of experience working with and analyzing large quantities of data

        • 2+ years of experience with Microsoft Word (create, edit, save), Microsoft Excel (pivot, formulas, VLOOKUP's, etc.), and Microsoft Access (Queries, reporting, edit, etc.)
          Preferred Qualifications:

          • Bachelor's Degree (or higher)

          • Healthcare-related background

          • Experiencing working in a matrix-style organization

          • Experience working with PL/SQL within an Oracle Data base

          • Experience with Medicaid Encounters, Medicaid Claims, or other related functions, such as Provider Data or Enrollment
            Telecommuting Requirements:

            • Reside within the state of Mississippi

            • 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:

              • Experience in working multiple priorities

              • Experience in problem solving and researching conflicting and / or inaccurate data

              • Experience in communicating analysis, including trends and opportunities, to partners and customers in writing and verbally
                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 https://uhg.hr/transitioning-military
                Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet
                Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 10 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
                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.
                Keywords: #RPO, #YELLOW

Keywords: UnitedHealth Group, Biloxi , Senior Claims Business Process Consultant - Work from Home, Professions , Biloxi, Mississippi

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