Senior Auditor - Data Integration Operations - National Remote
Company: UnitedHealth Group
Location: Hartford
Posted on: May 22, 2023
Job Description:
You'll enjoy the flexibility to telecommute* from anywhere
within the U.S. as you take on some tough challenges.At
UnitedHealthcare, we're simplifying the health care experience,
creating healthier communities, and removing barriers to quality
care. The work you do here impacts the lives of millions of people
for the better. Come build the health care system of tomorrow,
making it more responsive, affordable, and equitable. Ready to make
a difference? Join us and start doing your life's best work.SMThis
position will lead efforts for end-to-end Value Based Reimbursement
(VBR) operational issue resolution with a specific focus on data
integration touchpoints with the delegates, including misdirected
claims, authorization submissions, eligibility, provider remittance
advice etc. This position will be responsible for partnering
closely with our delegated provider partners, as well as, with
internal teams to improve the provider and member service
experience related to key VBR operational processes, leveraging
industry standard Electronic Data Interchanges (EDI) processes when
feasible. This position will serve as the lead analyst to develop
the control and monitoring framework to facilitate the resolution
of the root cause of these service issues.This will improve the
care provider experience by reducing the administrative burden that
the issues place on both UHC and the delegated provider. This
position will utilize their project management and analytical
skills, as well as extensive knowledge of the business and the
business processes to implement this operational infrastructure.
This position requires the ability to act independently to lead and
diagnose process improvement opportunities, strong relationship
building and collaboration across multiple teams, as well as the
ability to drive complex issues to resolution with minimal
supervision.This position is full-time. Employees are required to
work our normal business hours of 8:00am - 5:00pm. It may be
necessary, given the business need, to work occasional overtime or
weekends.*All Telecommuters will be required to adhere to
UnitedHealth Group's Telecommuter Policy.Primary
Responsibilities:
- Develop appropriate end to end controls and monitoring of key
capitation and delegation operational processes, including
misdirected claims, eligibility, provider remittance advice and
authorization data, etc.
- Provide appropriate operational subject matter expertise and
business analysis for system migrations and other projects related
to misdirected claims, authorization data, eligibility etc. end to
end processes.
- Root cause data integration related operational issues,
document findings and implement action plans, including
collaboration with external provider delegates and various internal
IT and business teams.
- Effectively communicate the issues, including any barriers or
risks to their resolution, with both internal and external parties.
Such communication may be written or verbal.
- Apply analytical and professional judgement to appropriately
resolve provider inquiries and issues.
- Implement standard operational processes for the delegated
membership across all platforms.
- Improve VBR operational metrics to achieve Company
standards.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:
- Bachelor's Degree (or higher)
- 3+ years of experience in communication, internal and external
executive level
- 2+ years of work experience in an Audit related role, such
Financial Audit, Internal Audit, or IT Audit
- 3+ years of experience developing and implementing business
process change initiatives, including documentation
- 3+ years of experience using operational metrics,
data/analytics, capacity planning, goals/objectives and dashboards
to run, interpret, and drive business performance
- Change Management experience
- Experience with process improvement, workflow, benchmarking and
/ or evaluation of business processes
- Experience with Microsoft office, including Microsoft Word,
Microsoft Excel, (Create, Edit, Pivot, formulas, vLookup, run
reports), and Microsoft Teams
- Ability to work full-time. Employees are required to work our
normal business hours of 8:00am - 5:00pm. It may be necessary,
given the business need, to work occasional overtime or
weekends.Preferred Qualifications:
- 2+ years of experience in an operational role within the
healthcare industry, such as within eligibility, benefits
management, or prior authorization
- Knowledge of UHC Claims Platforms
- Experience in the Health Care industry
- Experience performing financial analysis
- CPA, CISA, or MBA in Business Administration
- Intermediate proficiency with Microsoft office including
Tableau
- Experience identifying and evaluating technology risk and
controls
- Knowledge of Value Based Contracting or Capitated Delegated
Division of Responsibility business modelsTelecommuting
Requirements:
- Required to have a dedicated work area established that is
separated from other living areas and provides information
privacy
- Ability to keep all company sensitive documents secure (if
applicable)
- Must live in a location that can receive a UnitedHealth Group
approved high-speed internet connection or leverage an existing
high-speed internet serviceSoft Skills:
- Strong relationship skills
- High proficiency in analytical skills
- Experience leading/driving meetings and conversationsCareers
with UnitedHealthcare. Work with a Fortune 5 organization that's
serving millions of people as we transform health care with bold
ideas. Bring your energy for driving change for the better. Help us
improve health access and outcomes for everyone, as we work to
advance health equity, connecting people with the care they need to
feel their best. As an industry leader, our commitment to improving
lives is second to none.California, Colorado, Connecticut, Nevada,
Washington, or New York, Rhode Island Residents Only: The salary
range for California / Colorado / Connecticut / Nevada / Washington
/ New York / Rhode Island residents is $67,800 - $133,100. Pay is
based on several factors including but not limited to education,
work experience, certifications, etc. 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.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.#RPO #YELLOW
Keywords: UnitedHealth Group, Hartford , Senior Auditor - Data Integration Operations - National Remote, Accounting, Auditing , Hartford, Connecticut
Didn't find what you're looking for? Search again!
Loading more jobs...