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