Senior Claims Business Process Analyst

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.

As a Fortune 5 business, we’re one of the world’s leading healthcare companies. There are no limits here on the resources you’ll have or the challenges you’ll encounter.

We have been supporting global healthcare systems from Ireland and the UK for more than 20 years, building a dynamic and diverse team of more than 2,100 talented individuals. With a continued record of growth and stability, we’re on the constant lookout for fresh talent to join our expanding team’s healthcare system work better for everyone.

As a Senior Claims Business Process Analyst, you will be part of ClearHealth Strategies’ Independent Dispute Resolution(“IDR”) team. You will work with the IDR team in a quasi-legal process to assist in the review of disputes, eligibility analysis, and preparation of arbitration briefs in support of ClearHealth’s compliance with the federal No Surprises Act and state surprise billing laws. Using available state and federal guidelines, you will be an essential contributor throughout the IDR process, with focus on briefing and submission of documentation to an independent arbiter. This role will be expected to cogently respond to requests from CMS, independent arbiters, providers, clients, management, and other individuals throughout the day. Candidate should have the ability to work independently and follow defined standards and procedures with efficiency and accuracy.

The role offers continuous on-the-job training with a hands-on learning approach where you will first shadow others and then quickly be given straight forward tasks to complete to assist in learning and developing in the role. Training will be conducted virtually from your home.

Schedule: Full time, Monday – Friday. Employees are required to have flexibility to work in normal business hours of 9:00am – 5:30pm depending on time zone. It may be necessary, given the business need, to work occasional overtime.

Primary Responsibilities:

• Respond to inquiries from CMS, arbiters, providers, clients, and ClearHealth
• Prepare arbitration briefs
• Identify issues, analyze EOBs and claims information, apply critical thinking skills to formulate plan of action, and resolve issues independently
• Triage complex issues to management
• Manage multiple priorities in a time sensitive manner
• Work in fast-paced, high-volume environment with quick turnaround time
• Communicate effectively utilizing strong business writing skills
• Prioritize and manage workload to meet deadlines, goals, and objectives
• Collaborate with coworkers in cohesive team environment

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:

• Bachelor’s Degree (or higher) OR equivalent work experience
• Experience analyzing and solving customer problems
• Experience root cause analysis utilizing data
• Litigation/legal background or investigative support experience
• Experience with Microsoft Excel (data entry, pivot tables); Microsoft Word; Microsoft Outlook; Microsoft PowerPoint

Preferred Qualifications:

• Experience in medical claims processing is helpful, but not mandatory
• Ability to Maintain compliance with HIPPAA privacy and security guidelines at all times

Soft Skills:

• Ability to manage multiple priorities in a time sensitive manner
• Ability to meet deadlines and establish appropriate priorities while working within a team environment
• Manages workload, works efficiently, meets goals and objectives
• Work in a fast-paced environment
• Ready to work, ready to learn attitude
• Integrity, accountability, and ability to maintain confidentiality

Please note you must currently be eligible to work and remain indefinitely without any restrictions in the country to which you are making an application. Proof will be required to support your application.

All telecommuters will be required to adhere to the UnitedHealth Group’s Telecommuter Policy.

 

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 marginalised 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: Optum is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to gender, civil status, family status, sexual orientation, disability, religion, age, race, and membership of the Traveller community, or any other characteristic protected by law. Optum is a drug-free workplace. © 2024 Optum Services (Ireland) Limited. All rights reserved.

  

 

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