Location: Minneapolis Minnesota United States
Contest Number: 804088
Title: Recovery / Resolution Consultant – US Telecommute
Function: Claim Recovery/Resol/COB/Subro
BusinessSegment: UHC Benefit Ops – Corporate
Region: North America
Country: United States
Welcome to one of the toughest and most
fulfilling ways to help people, including yourself. We offer the latest tools,
most intensive training program in the industry and nearly limitless
opportunities for advancement. Join us and start doing your life’s best work.
We’ll put you in the driver’s seat on vital projects that have strategic importance to our mission of helping people lead healthier lives. Yes, we share a mission that inspires. We need your organizational talents and business discipline to help fuel ours. It’s the opportunity to do your life’s best work.
Positions in this function include those responsible for designing / developing, programming and maintaining Waste Scrapes (Visual Studio Executables), to clear out false positives from SAM Edits. Provides operational support for production and non – production applications, report out metrics and program health. May make recommendations based on the analysis, and provide explanations for reporting results as needed. May be done for internal operational purposes as well as for customers.
The Recovery / Resolution Consultant will lead the creation and implementation of SAM edit waste scrapes (visual studio executables) to assist with capacity constraints and provide subject matter expertise for automation projects on the UNET platform and others as needed. Will partner with the CCM and National SAM edit teams to ensure consistency across analytics.
Exploring alternative automation solutions for correct claim payment
Creating / maintaining Waste Scrapes to limit false positives from SAM / SEAL / CIRE, etc.
Partner with the Automation Team for enhancing Edit Rules to increase savings
Collaborate with Business Analysts and Edit Rule Owners to find automation opportunity in the National space, develop, deploy and provide maintenance for automation.
Collaborate with Optum Business Partners for CCM savings opportunities
Serve as subject matter resource and assist with analysis for department system enhancements and business analysis
High School Diploma / GED (or higher)
2+ years of Continuous Programming experience
2+ years of experience with C+ or Visual Basic
2+ years of VB.net, C#, Python experience
2+ years of SQL experience
2+ years of experience analyzing and problem solving
2+ years of report modeling and implementation
2+ years of experience with Microsoft Visio or other process flow creation tools
2+ years of experience performing Data Analytics
2+ years as an Independent Contributor
Strong proficiency with Microsoft Excel (basic formulas, tables, charts, VLOOKUP, concatenate, IF, THEN statements, etc.)
Able to work on multiple projects and effectively prioritize
Bachelor s Degree (or higher) in Computer Science
A strong understanding of the SAM Edit system from both a claim life cycle and behind the scenes system perspective
2+ years of Program or Project management experience
2+ years of Healthcare experience
2+ years of experience with tableau reporting
2+ years of experience with Java
2+ years of experience with RPA and JIRAPhysical Requirements and Work Environment:
Extended periods of sitting at a computer and use of hands / fingers across keyboard or mouse
Home or in – hou…
Computer & IT , Consulting , Insurance , Insurance Claims , Medical & Health , Project Management