Provider Relations Coordinator - Orange County, CA

Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)

The Provider Relations Coordinator is responsible for assisting in the full range of provider relations and service interactions within UnitedHealth Group, including working on end-to-end provider claim and call quality, ease of use of physician portal and future service enhancements, and training & development of external provider education programs. Provider Service Representatives assist in the design and implementation programs to build and nurture positive relationships between the health plan, providers (physician, hospital, ancillary, etc.), and practice managers. Other responsibilities include supporting those who direct and implement strategies relating to the development and management of a provider network, identify gaps in network composition and services to assist the network contracting and development staff in prioritizing contracting needs, and may also be involved in identifying and remediating operational short-falls and researching and remediating claims.

Primary Responsibilities:

• Develops strong familiarity with the assigned regional network, supporting the efforts of the Regional Team to enhance the relationship with the network's providers


• Researches issues communicated by network providers either telephonically or electronically


• Manages the Provider Grievance and Dispute process


• Relays claim disputes promptly to Claims Department


• Prepares materials for provider training in-services


• Maintains accurate and timely provider information in company databases


• Assists in tracking/monitoring of network providers' performance and assists in the distribution of Physician Incentive bonuses


• Ensures that provider offices have a Practice Connect account assigned and trained, as needed, in accordance with guidelines and handles any questions about account


• Maintains and assists in distribution of the New Provider Tracking Log


• Communicates information about provider changes in assigned regional network


• Ensures that regional network providers have been loaded and plan-specific provider identification numbers have been assigned

Required Qualifications:

• High school diploma


• 1+ years of experience in a claims, customer service or provider support role


• Ability to work independently and remain on task


• Good organization and planning skills


• Strong interpersonal and oral communication skills including telephone etiquette


• 1+ years of  claims research and analysis


• Beginner level of proficiency with MS programs including Excel and Word


• Valid CA driver's license

Preferred Qualifications:

• 2+ years of managed care or medical insurance experience

What's the first thing that happens when one of the most successful physician groups in Orange County comes together with a global leader in health care? Opportunity. With Monarch HealthCare joining Optum and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. With a vibrant network of hospitals and urgent care centers, we're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity to do your life's best work.(sm)

Diversity creates a healthier atmosphere: All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, protected veteran status, or disability status.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.

Job Keywords: claims, research, customer service, provider support, network, Orange County, CA