Solid understanding of both fully insured and self funded marketplace and pricing disciplines Establish and maintain "strong and appropriate" level relationships with customers and consultants; ensure UHG senior management has customer specific "board level" contacts Develop and monitor client financial performance including renewal planning, negotiation and profitability

Perform clinical assessment of healthcare services provided to our members for appropriateness Understand relevant state and federal grievance and peer review requirements and accreditation standards applicable for processes supported Receives cases from the QIS non clinical team and reviews them against required clinical information, assessing for appropriateness and con

Key Agent/Agency Performance Agent Development Mentor, coach and engage key agents/agencies through ongoing business and strategy planning. This includes identifying sales opportunities, product positioning, UHC tools, UHC value proposition, compliance, and market education Onboarding Reach out to new agents identified by the PHD to share UHC learning, growth tools and va

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 to start Caring. Conne

Respond to and resolve on the first call, customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence Educate customers about the fundamentals and benefits of consumer driven health care, guiding them on topics such as selecting the best benef

Clinical Appeals and Grievances (analyzing, reviewing appeals / grievances) Review of coding edits and reimbursement issues Works with less structured, more complex issues Solves moderately complex problems and / or conducts moderately complex analyses Translates concepts into practice Assesses and interprets customer needs and requirements Identifies solutions to non sta

Take ownership and responsibility for the design and development of all aspects of manual and automated test approach and strategy. Author and execute the Test Suite of manual and automated test scenarios with traceability to requirements to validate the application. Collaborate with business team members to review and clarify requirements and acceptance criteria for all

Answer incoming phone calls from customers and identify the type of assistance the customer needs (i.e. benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits (EOBs) Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems Own problem t

Manages ongoing relationships and service delivery to clients for one or more accounts Acts as outward facing, dedicated resource for assigned accounts, typically with direct client contact (not call center) and large or complex accounts Works closely with Sales Leads on renewals and upselling, but incumbents do not have specific sales goal accountability or primary respo

Sort and file patient demographic forms (may include lifting up to 30 lbs.) Locate and retrieve patient demographic forms when requested. Cross train and work in all processes when needed Other duties as assigned Repetitive movements including sit, stand, kneel, reach You'll be rewarded and recognized for your performance in an environment that will challenge you and give

Interpret and analyze claims, capitation, membership data, and recommend best approaches in support of underwriting, actuarial and utilization analyses Lead projects to completion by contributing to database creation, statistical modeling and financial reports Performs complex data validation and conceptual analyses. Create and update automated processes within client dat

Assess, plan, and implement care strategies that are individualized by the member and directed toward the most appropriate, lease restrictive level of care Utilize both company and community based resources to establish a safe and effective case management plan for members Collaborate with patient, family, and healthcare providers Identify and initiate referrals for socia

As requested, provide support to consumer or family members in making needed appointments Work with the Clinical Program Managers and the Clinical team to implement intensive, enhanced care coordination when requested, which may include peer support as well as other community based services designed to stabilize the consumer's condition, including working with the consume

Answer incoming phone calls from prospective members, identify the type of assistance and information the customer needs with the goal to convert caller to a qualified lead and sale Follow up with members on questions or to review current or new products and services Navigate multiple computer systems to document member information while maintaining active listening and e

This is a hands on position that requires strong debugging and troubleshooting skills within Electrical, Mechanical, Pneumatic and PLCs Identify training needs and tracks OJT to ensure craftsmen base is maintained and improving Install, setup, troubleshoot, and maintain various mail order pharmacy equipment and prototyping/testing new improvement projects Ability to troub