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

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

Maintains and oversees the loading of benefit plan information and contract configuration into claims processing system to ensure claims payment accuracy and consistency. Maintains and configures appropriate authorization guidelines within benefit modules. Supports interdepartmental teams through benefit plan processing, authorization accuracy and contract configuration accuracy, analysis, and maintenance. Provides additional support to interdepartmental teams regarding plan benefits and contract configuration. Day to day will vary depending on volume or projects. Need to be able to multi-task and cover the inventory. Responsible to be able wo work on various tasks. Candidates need to be flexible, be an independent worker, have good critical thinking skills and good time management. Part of 6 member team. Weekly team huddles and more if needed.

This position is full-time, 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 CST. It may be necessary, given the business need, to work occasional overtime.

We offer 1 week of formal on-the-job training. The hours of the training will be 8:00am – 5:00pm, Monday – Friday and then continuous on-the-job training.

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

Primary Responsibilities:

• Manages and configures benefit plan configuration methodologies within specified timeframes into claims payment system

• Manages and configures contract configuration methodologies within specified timeframes into claims payment system

• Understands and maneuvers within health plan partner online websites

• Tests and audits claims payment accuracy against benefit and contract configuration loaded into claims payment system

• Partners with other departments to ensure appropriate data is collected and maintained

• Interprets and configures benefit and contract terms and claims coding in a risk based environment

• Understands health insurance benefit administration in a risk based environment

• Implementing and configuring new benefit plan information for new business strategies

• Acts as a resource to other internal departments on benefit issues

• Expected to meet or exceed departmental timeframes and quality metrics on a consistent basis

• Takes ownership of the work process, seeks ways to improve job and process efficiency and makes appropriate suggestions and solutions to management

• Ability to multitask and change focus to accommodate meeting of team objectives and deadlines

• Performs all other related 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 years of experience

• 5+ years of health care claims processing experience

• 2+ years of Benefit Configuration experience

• Experience with Medical terminology, 10-key and computers including Windows based programs

• Experience with Microsoft Word, Microsoft Excel, Microsoft Teams and Microsoft Outlook

• Experience navigating multiple systems

• Experience with Medicare processing guidelines, RBRVS, facility and ambulatory payment methodologies

• Must be 18 years of age OR older

• Ability to work full-time, Monday – Friday between 8:00am – 5:00pm CST including the flexibility to work occasional overtime given the business need

Preferred Qualifications:

• Medical coding certification

• Experience in contract configuration loading

• Experience in credentialing, contracting or utilization management

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.

Soft Skills:

• Exceptional ability to organize, prioritize and communicate effectively

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington or Rhode Island Residents Only: The hourly range for this is $23.22 – $45.43 per hour. 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: * This 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.

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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