Sr. Claims Business Process Consultant – 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.

 

We are seeking a dynamic and experienced People Leader to oversee our Standard Operating Procedure (SOP) team within the Appeals & Grievances (A&G) function. This role is critical to ensure that our operational procedures are compliant, efficient, and aligned with regulatory and business needs. The ideal candidate will bring a passion for process excellence, team development, and cross-functional collaboration. You’ll be part of a mission-driven team that values integrity, innovation, and continuous improvement. If you’re passionate about leading people and driving operational excellence, we’d love to hear from you.

 

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

 

Primary Responsibilities:

• Leadership & Team Development
• Lead, coach, and develop a team of SOP specialists
• Conduct regular performance reviews, career development planning, and coaching sessions
• Foster a culture of accountability, collaboration, and continuous improvement
• SOP Management & Operational Oversight
• Oversee the full lifecycle of SOPs: drafting, reviewing, publishing, and updating
• Ensure SOPs reflect current tools and workflows (e.g., ATS, DOC360, ICUE)
• Collaborate with cross-functional teams to ensure SOPs support accurate and timely case processing
• Compliance & Quality Assurance
• Ensure SOPs meet CMS, state, and internal compliance standards
• Partner with Regulatory Adherence and Quality teams to address gaps and implement corrective actions
• Support audit readiness and documentation accessibility
• Strategic Planning & Innovation
• Contribute to strategic initiatives such as automation, portal integration, and dashboard deployment
• Identify and implement process improvements to enhance efficiency and reduce cycle times
• Participate in leadership forums and share best practices across teams

 

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 or GED 
• 2+ years of leadership experience in appeals, grievances, or claims operations
• Process Mapping
• Familiarity with JIRA or other intakes to manage inventory
• Solid understanding of SOP development and regulatory compliance
• Excellent communication, coaching, and stakeholder engagement skills
• Familiarity with tools such as ATS, ETS, UNET, and Microsoft Copilot/Editor is a plus

 

Preferred Qualifications:

• Demonstrated interest or experience in leveraging AI, automation, or digital tools to improve operational workflows, enhance documentation accuracy, or streamline SOP management.
• HTML/Knowledge Central/Engagement Management tools
• Project management & task delegation experience
• Excellent interpersonal skills and the ability to influence all stakeholders and interested parties
• Ability to prioritize own work as well as work of others

 

*All employees working remotely 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 re 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 salary for this role will range from $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

 

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.