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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. Connecting. Growing together.

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

We offer on the job training. The hours during training will be 8:00 AM - 5:00 PM CST from Monday - Friday.

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

Primary Responsibilities:

• Execute the build and implementation of benefit plan adjudication rules

• Coordinate the integration or conversion of new clients and / or products as needed, often under aggressive timelines

• Participate in the development and implementation of an enterprise claim platform, providing subject matter expertise on the system configuration and usability components

• Align operational needs with technology requirements

• Develop best practices and standard operational procedures for creating and configuring benefit plans

• Establish consistency and standardization as it relates to tools and processes (deliverable templates, change management processes, business models, process flows, etc.)

• Curate a robust testing suite that is representative of all coverage to better quantify the impact of introducing configuration changes.

• Ability to execute testing to ensure the accurate configuration of business requirement

• Analyze larger sets claims data to evaluate patterns of billing as it relates to benefit design and configuration

• Partner with claim processors, member service and provider service to identify and resolve issues related to the plan configuration

• Perform 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 equivalent work experience

• Must be 18 years of age OR older

• 3 + years of business and operations experience in a health plan environment, including proficiency with ICD-10, CPT, HCPCS, revenue codes, and medical terminology

• 2+ years of experience in data analysis

• 1+ years of experience with SQL, including understanding and creating queries

• Experience with the plan build / plan configuration of claim adjudication platform

• Experience with commercial health plan design

• Experience with project methodology (requirements, design, development, testing, and implementation), inclusive of Scrum and Kanban

• Ability to work any shift between the hours of 8:00 AM - 5:00 PM CST from Monday - Friday including some flexibility based on business need

Preferred Qualifications:

• 3+ years of experience with using Microsoft Excel (creating, editing, and saving worksheets)

• 1+ years of experience in a healthcare environment with HIPAA, ERISA, and ACA requirements

Telecommuting Requirements:

• Ability to keep all company sensitive documents secure (if applicable)

• Required to have a dedicated work area established that is separated from other living areas and provides information privacy

• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy  

The hourly range for this role is $28.61 to $56.06 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

Application Deadline: T his will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

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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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