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Senior Claims Business Process Analyst - Cypress, CA; Sugar Land, TX; Tampa, FL
•30 days ago
| Hours | Full-time, Part-time |
|---|---|
| Location | Cypress, CA Cypress, California |
About this job
Position Description:
Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.
Flexible, Friendly, Fast on your feet, that's a great start. Accurate, Accountable, Self Directed, These traits can take you places. Our claims operations are the focal point of handling information about services patients receive and they way those services get paid. It's complex, detailed work. It's fast paced challenge. It's a job that calls on you to be thoughtful, resourceful, team-driven and customer-focused. To put it mildly, there is never a dull moment. Senior Claims Business Process Analysts are responsible for all related aspects of claim system processes and claim business rules. Include claims systems utilization, capacity analyses/planning and reporting, claims-related business and systems analysis. Ensure data integrity, data security and process optimization.
Purpose of Job: This position (1) manages intake of all written State and Federal Regulator complaints received by the Regulatory/Consumer Affairs unit, MEDIC RFI, Legal Risk Management, CRCT (DMHC complaints); (2) identifies correct legal entity, jurisdictional requirements, and complaint contact for each complaint received; (3) manages the relationship and complaint handling with internal/external complaint contacts outside the Regulatory Complaint Team; and (4) prepares reports on volume, trend, and root cause.
Primary Responsibilities:
Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.
Flexible, Friendly, Fast on your feet, that's a great start. Accurate, Accountable, Self Directed, These traits can take you places. Our claims operations are the focal point of handling information about services patients receive and they way those services get paid. It's complex, detailed work. It's fast paced challenge. It's a job that calls on you to be thoughtful, resourceful, team-driven and customer-focused. To put it mildly, there is never a dull moment. Senior Claims Business Process Analysts are responsible for all related aspects of claim system processes and claim business rules. Include claims systems utilization, capacity analyses/planning and reporting, claims-related business and systems analysis. Ensure data integrity, data security and process optimization.
Purpose of Job: This position (1) manages intake of all written State and Federal Regulator complaints received by the Regulatory/Consumer Affairs unit, MEDIC RFI, Legal Risk Management, CRCT (DMHC complaints); (2) identifies correct legal entity, jurisdictional requirements, and complaint contact for each complaint received; (3) manages the relationship and complaint handling with internal/external complaint contacts outside the Regulatory Complaint Team; and (4) prepares reports on volume, trend, and root cause.
Primary Responsibilities:
- Review written correspondence and route non-scope issues to the appropriate business partner within same business day as receipt.
- Check various systems to identify key factors in identifying correct entity to handle policy
- Maintain a log of all complaints received
- Forward complaints handled by partner contacts (AARP, Empire, Americhoice, etc)
- Capture partner complaints in database
- Scan all materials and route to appropriate owner
- Assist Regulatory Advocates researching complex complaints by:
- Obtain relevant plan documents and provider contracts.
- Obtain relevant UHG documents (e.g., reimbursement or coverage policies, state mandates, P&Ps, etc.)
- Prepare complex claims projects for Network Services and Claims Dept review.
- Prepare weekly, monthly, and quarterly reports, to include:
- Volume trends by complainant type
- Issue trends by complainant type, customer, geography, etc.
- Root cause.
Requirements
Requirements:
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.
Diversity creates a healthier atmosphere: 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.
- An education level of at least a High School Diploma or GED
- 2+ years of Regulatory Affairs, Customer Service experience
- 2+ years of Managed Care experience
- Working knowledge of internal databases and sources of claim and benefit information
- 1+ years of Claims experience
- Intermediate MS Word and MS Excel
- Excellent organizational skills
- Ability to follow a project through to completion.
- Ability to work under time constraints.
- Outstanding written and verbal communication skills.
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.
Diversity creates a healthier atmosphere: 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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