Coordination of Benefits Community and State Plan Strategist – National Remote

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.  

You’ll join a high caliber team where you’re assisting, educating, problem-solving and resolving tenuous situations to the best possible outcomes. Bring your people skills, emotional strength, and attention to detail. In return we offer the latest tools and most intensive training program in the industry. Get ready to start doing your life’s best work. Coordination of Benefits Community & State Plan Strategist is responsible for meeting contractual and compliance requirements related to Coordination of Benefits for the supported Health Plans. The Coordination of Benefits Community & State Plan Strategist high level focus is on the financial impact / cost savings to UHG, efficiency of COB processes, and compliance with state and federal requirements.

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.

We offer 2 weeks of on-the-job training. The hours of training will be aligned with your schedule.

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

Primary Responsibilities:

• Develop operational documentation that includes workflow use cases, context diagrams, requirements documents, operational support documentation, test cases and training material.
• Drive Coordination of Benefit (COB) business/regulatory requirements for all UHC business segments. Heavy focus on new business implementation, system migrations and expansions through collaboration with all functional areas.
• Monitor program monthly financial performance by comparing and analyzing forecast saving against actual results to ensure financial goals are met; address and remediate gaps.
• Seek out and lead project opportunities to drive the identification of new COB information and the improvement of COB processes.
• Take leadership and ownership of existing projects to maximize COB cost avoidance.
• Lead internal/external vendor activity by driving work effort and/or providing Subject Matter Expert’s (SME) regulatory requirements.
• Track vendor and internal operational team quality of work, performing audits as needed.
• Work with internal operational teams (COB Ops) to manage cost avoidance loading and validation process.
• Research escalated COB issues and concerns, to identify root causes of problems or explain misinterpretations of COB outcomes.
• Drive file crosswalk and/or mapping projects.
• Through collaboration with the C&S Encounters Team, proactively research and manage COB Encounters and other COB information to prevent Encounter Rejections

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:

• 2+ years of leading projects or driving initiatives to completion.
• 1+ years of experience CSP Facets system
• 1+ years of experience with Medicare and/or Medicaid claims experience (i.e. processing, reviewing, auditing, billing etc.)
• Must be 18 years of age or older
• Ability to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm.

Preferred Qualifications:

• Claims or data auditing experience
• Project Management Certification (i.e., PMP, PMI, Agile, Six Sigma)

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:

• Ability to manage multiple projects with competing priorities
• Ability to handle aggressive timelines

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington or Rhode Island Residents Only: The hourly range for this is $28.03 – $54.95 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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