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  • Phoenix, AZ

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Recovery / Resolution Consultant - US Telecommute

UnitedHealth Group • Phoenix, AZ

Posted 8 days ago

Job Snapshot

Full-Time
Healthcare - Health Services
General Business, Health Care

Job 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.

We'll put you in the driver's seat on vital projects that have strategic importance to our mission of helping people lead healthier lives. Yes, we share a mission that inspires. We need your organizational talents and business discipline to help fuel ours. It's the opportunity to do your life's best work.
Positions in this function include those responsible for designing / developing, programming and maintaining Waste Scrapes (Visual Studio Executables), to clear out false positives from SAM Edits. Provides operational support for production and non - production applications, report out metrics and program health. May make recommendations based on the analysis, and provide explanations for reporting results as needed. May be done for internal operational purposes as well as for customers.
The Recovery / Resolution Consultant will lead the creation and implementation of SAM edit waste scrapes (visual studio executables) to assist with capacity constraints and provide subject matter expertise for automation projects on the UNET platform and others as needed. Will partner with the CCM and National SAM edit teams to ensure consistency across analytics.
Primary Responsibilities:
  • Exploring alternative automation solutions for correct claim payment
  • Creating / maintaining Waste Scrapes to limit false positives from SAM / SEAL / CIRE, etc.
  • Partner with the Automation Team for enhancing Edit Rules to increase savings
  • Collaborate with Business Analysts and Edit Rule Owners to find automation opportunity in the National space, develop, deploy and provide maintenance for automation.
  • Collaborate with Optum Business Partners for CCM savings opportunities
  • Serve as subject matter resource and assist with analysis for department system enhancements and business analysis

Requirements:
  • High School Diploma / GED (or higher)
  • 2+ years of Continuous Programming experience
  • 2+ years of experience with C+ or Visual Basic
  • 2+ years of VB.net, C#, Python  experience
  • 2+ years of SQL experience
  • 2+ years of experience analyzing and problem solving
  • 2+ years of report modeling and implementation
  • 2+ years of experience with Microsoft Visio or other process flow creation tools
  • 2+ years of experience performing Data Analytics
  • 2+ years as an Independent Contributor
  • Strong proficiency with Microsoft Excel (basic formulas, tables, charts, VLOOKUP, concatenate, IF, THEN statements, etc.)
  • Able to work on multiple projects and effectively prioritize
Preferred Qualifications:
  • Bachelor’s Degree (or higher) in Computer Science
  • A strong understanding of the SAM Edit system from both a claim life cycle and behind the scenes system perspective
  • 2+ years of Program or Project management experience
  • 2+ years of Healthcare experience
  • 2+ years of experience  with tableau reporting
  • 2+ years of experience with Java
  • 2+ years of experience with RPA and JIRA
Physical Requirements and Work Environment: 
  • Extended periods of sitting at a computer and use of hands / fingers across keyboard or mouse
  • Home or in - house office environment
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 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.
Keywords: UHG, United Healthcare, Recovery resolution, subject matter resource.
Job ID: 2551_804088_2
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