CPM Provider Service Representative

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. 

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

Primary Responsibilities:

• Accountable for ownership of provider claim projects in an end-to-end process, from initial communication, identification of claim payment issue, facilitation of resolution of claim payment issues and communication of outcome
• Ability to educate provider on details of UHG reimbursement policies. etc., and related claim issues for the E&I Commercial Unet products
• Must possess a strong working knowledge of the E&I Commercial Unet products with the ability to interpret and apply guidelines, regulations, and mandated benefits
• Interact directly with market providers and internal office staff in the resolution of claim issues
• Resolve complex provider claim issues; support fellow team members and provide feedback to Leadership as needed
• Maintain ongoing communication throughout the project process
• Research claims to determine accuracy and identify high level root cause of any claim payment issues
• Ensure consistent quality service to UHGs customers
• Meet or exceed all productivity, turnaround time, and quality assurance expectations and guidelines
• Research complex issues while navigating multiple platforms and databases
• Work with project contact to gather information, prepare and submit claims for reconsideration, if applicable. Ensure accurate project submission based on the identified root cause
• Upon project completion by CRT, audit project results, send rebuttals as necessary
• Prepare and send project results to project contact, conduct final project contact call to review project outcome and ensure satisfaction with project results
• Maintain documentation of all project activities and communications within the CPM application
• Serve as primary point of contact for project submitters in resolution of claims project issues
• Maintain compliance with all Federal/State regulations and UHG policies
• Collaborate with other business partners to gather data needed for resolution
• Works all provider types
• Manages complex or escalated global projects
• Escalated and formal complaint high volume projects
• Take ownership for self-development by actively engaging in CLL practices

A Typical Day in the Life:

• Perform root cause analysis on claim projects
• Request and audit claim impact reports
• Route impacted claims to the claim adjustment unit for re-processing
• Perform backend audits to ensure claims were re-processed correctly
• Communicate with internal and external business partners
• Read and respond to emails
• Complete training as required
• Handle special projects assigned by manager
• Make outbound calls to providers as required
• Take ownership and follow through on outstanding issues
• Serve as single point of contact for internal and external business partners for claim projects
• Attend required calls

Skills You Will Gain:

• Communication skills
• Deeper understanding of business partners operations
• Enhanced understanding of claim processing procedures
• Big picture view of the organization
• Ability to influence without authority
• Broader network of internal contacts

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 higher) 
• 2+ years of current experience with applicable claims platform (UNET)
• 2+ years of NDB/Contract knowledge experience
• 2+ years of experience with UHG processes, systems, and products for the platform you are applying for
• 2+ years of experience with physician, facility, and ancillary claims
• 2+ years of prior experience working directly with provider/submitters
• Intermediate level of proficiency with MS Office (Word, Excel, Outlook)

Preferred Qualifications:

• Undergraduate degree
• Must be employed within UHC Provider Operations

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

 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $23.41 to $41.83 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 

 

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. 

 

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.

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. 

 

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.

 

 

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