Requisition number: 2393693
Job category: Network Management
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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
The more you do, the more you learn. As you learn, you'll discover new opportunities to grow, make an impact, and bring your best every day. As a Provider Relations Advocate with UnitedHealth Group, you'll play a critical role in strengthening provider partnerships and improving the health care experience for providers and members alike.
We're building solider, more effective provider networks every day. In this role, you'll serve as a trusted resource and advocate for providers, using your customer service skills, managed care knowledge, and claims expertise to help resolve issues and improve the provider experience. You'll have the opportunity to deepen your understanding of provider relations, network operations, claims processes, and health plan administration while gaining exposure to a broad range of business partners and functions across the organization.
In this role, you will serve as a liaison between the health plan and provider community, leveraging your expertise in managed care operations, provider servicing, claims resolution, reimbursement processes, and network management. The ideal candidate has experience working for a health insurance carrier, managed care organization (MCO), or within a payer operations environment and understands the challenges providers face when navigating health plan processes.
What Makes This Role Unique
This individual contributor role is ideal for early to mid-career professionals who have worked on the payer side of healthcare and enjoy building relationships while solving operational challenges. You'll collaborate with providers and internal stakeholders to improve processes, resolve complex issues, and enhance overall provider satisfaction.
*If you are located within Philadelphia Metro Area, you will have the flexibility to work remotely as you take on some tough challenges.**
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 education or equivalent experience
3+ years of experience working for a health insurance carrier, managed care organization, or payer operations team
1+ years of provider relations, provider services, network management, or provider network experience
Experience resolving provider issues involving claims adjudication, reimbursement, eligibility, prior authorization, credentialing, or enrollment processes
Experience collaborating with cross-functional operational teams including claims, network, provider services, and customer operations
Intermediate proficiency with Microsoft Word, Excel, and PowerPoint
Preferred Qualifications:
3+ years of provider relations, provider account management, or provider service experience
Experience working for a health insurance carrier, managed care organization (MCO), or third-party administrator (TPA)
Experience supporting provider networks and provider-facing operational initiatives
Experience with Medicare and Medicaid regulatory requirements
Experience analyzing provider trends and recommending operational improvements
Solid understanding of claims adjudication, reimbursement methodologies, provider appeals, and payment resolution processes
Knowledge of provider contracting, credentialing, and network development functions
Familiarity with provider data management, eligibility systems, and authorization processes
*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 are 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 $60,200 - $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.
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.