Provider Advocate – Tribal Operations – National Remote

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 (40 hours / week), Monday – Friday. Employees are required to have flexibility to work any shift schedules during our normal business hours of 8:00 am – 5:00 pm CST.  It may be necessary, given the business need, to work occasional overtime. 

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

  

Primary Responsibilities:  

• Confirm contract compliance to meet the needs of the Turquoise Care contract 
• Experience working with providers/facilities to conduct advocacy actives with ITU’s 
• Work with cross-functional teams within UnitedHealthcare including but not limited to behavioral health, physical health, dental and vision 
• Work with internal groups to identify, understand, and / OR improve internal tools, resources, systems, and capabilities that can maximize provider and member experience 
• Analyze data to determine root cause of issue (e.g., identify trends and patterns; identify outliers and anomalies) and / OR escalate problem to appropriate group for further analysis as necessary 

Included in this role is the full range of provider relations and service interactions within UHG, including working on end-to-end problem resolution. Identifies network gaps and assists in the development and implementation of strategies to fill these gaps. 

  

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
• 2+ years of experience with claims processing in Facets 
• Experience with Medicaid OR previous Managed Care Contract (MCO) 
• Experience with Microsoft office programs including Microsoft Word (creating and editing documents), Microsoft Excel (creating spreadsheets) and Microsoft Outlook (managing e-mail and calendar)  
• Experience with communicating clearly and professionally with Providers
• Ability to travel locally up to 10% of the time
• Ability to work between the hours of 8:00 AM – 5:00 PM CST from Monday – Friday including the flexibility to work occasional overtime based on business need

    

Preferred Qualifications: 

• Experience with Tribal providers (ITU)
• Speak one OR more Native American languages 
• Time management, organizational, and prioritization skills and ability to balance multiple priorities     
• Experience in Provider demographic loads
• Reside within New Mexico 

  

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