California Claims and PDR Implementation

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

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

Primary Responsibilities:

• Assesses and interprets customer needs and requirements.
• Makes recommendations and decisions for loading strategy for new market/payor configuration in Facets
• Gather technical and business requirements and responsible for documentation of business and process requirements
• Serve as primary subject matter expert to critically assess impact of non-standard implementation requests to claims and payment teams
• Act as escalation lead for identified risks; work with operational areas to develop and execute risk mitigation plans
• Maintain and foster collaborative working relationships with external stakeholders, internal SMEs, vendors and internal team members
• Responsible for the coordination and completion of projects, in addition to the management of Claim Operations readiness tasks and timelines while adhering to Quality and Compliance requirements
• Facilitate and manage mid-size workgroups, enabling a culture of collaboration, trust and disciplined accomplishment of tasks and target dates.
• Make presentations to management on project updates, project cycle, and expected results
• Lead or contribute to the development of program or project scope statements, in consultation with applicable stakeholders
• Develop and maintain detailed project plans (including resource assignments, schedules, dependencies, etc.) and Ensures projects are completed on time and in scope
• Monitor and report progress throughout the project life cycle, using appropriate project planning and scheduling tools (e.g., dashboards, metrics)

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:

• 2+ years of project management experience
• 2+ years of working within healthcare/payor setting including claims operations
• 2+ years of gathering and documenting business requirements, creating and managing project plans, and developing workflows
• Solid knowledge of business end-to-end processes that impact provider data, pricing, benefit administration and/or claims processing
• Proven ability to demonstrate flexibility in dynamic project environments with the ability to adapt to changing project requirements and priorities

Preferred Qualifications:

• Experience or exposure to provider dispute resolution.
• Experience with OptumCare Strategic Platform (OCSP) or a UHC Secondary Platforms (CSP Community & State Facets or other Claim platform)
• Experience with managing system migrations or implementations from a claim perspective
• Experience with claims processing or provider billing/back office revenue cycle
• Experience Medicaid or Medicare or Commercial or Exchange payment operations
• Experience with Capitation
• Experience with cross-functional and line of business program management
• Proficiency with MS Word, Excel, PowerPoint, Visio, and SharePoint
• Proven strategic thinking ability to align project activities with organizational strategies contributing to overall business success
• Demonstrated ability to communicate ideas clearly and concisely in writing and orally to individuals and groups

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

California, Colorado, Connecticut, Hawaii, Maryland, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The salary range for this role is $88,000 to $173,200 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

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.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and 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.