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We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM


Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com


Job Category:

OptumInsight Consulting



Approximate Salary:

Not Specified

Position Type:

Full Time

***Senior Consultant, Health Plan / Payer Operations

UHG - Minnetonka, Minnesota

Posted: 12/12/2018

As a Senior Consultant you'll provide consulting services to strengthen and improve health care operations that result in stronger financial returns and a healthier health care system. You'll use your strong strategic and business acumen to work closely with clients to define, develop and document business requirements to ensure needs are captured and critical deliveries are executed. This consulting career gives you the opportunity to travel and share in a mission that inspires. You'll see your ideas come to life and your achievements recognized. You won't find tougher challenges. And you won't find smarter people working together to solve them. Join us and start doing your life's best work.(sm)


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


Primary Responsibilities:
We are seeking candidates who have health plan operations experience and previous management consulting experience in one or more of the following areas of Health Plan Operations:
  • Health Plan Operations
    • Core Administration: Health plan operational departments and their primary and cross-departmental functions and operations (aka: health plan value chain), administrative cost containment, regulatory requirements and compliance, health plan product types (fully insured, self-insured, managed care, HMO, PPO)
    • Lines of Business: Commercial, ACO, Managed Medicaid, Medicare Advantage
    • Health care and health insurance markets and driver
  • Health Plan Management Consulting
    • Process Improvement: process management and improvement, root cause analysis, problem solving, policies and procedures, desk-level procedures, training
    • Business Analysis: business requirements development, business analysis, gap identification, process and work flows design
    • Project Coordination / Management: documentation, meeting facilitation, project planning
    • Data Management: data analysis and financial analysis
    • Client relationship development and management
    • Business development and revenue growth
  • Domain expertise and previous management consulting experience in one or more of the following additional areas:
  • Claims Processing
    • Claims adjudication / processing activities for a core claims administrative system (Facets, QNXT, HealthRules, Ika, etc.)
    • Clinical editing systems (ClaimCheck, CES) configuration and operations
    • Claims reimbursement analysis
    • Claims research and adjustment
    • Claims Third Party Liability and subrogation processing
    • Claims system configuration: processing rules, edits and pends
    • Other health plan operations impacts on claims: provider contracting, referrals and authorizations, benefit plan design and configuration
  • Call Center
    • Member, Provider and Claims call center operations core administrative systems for call management, scheduling, CRM, IVR
    • Appeals and Grievance processes
  • Provider / Network
    • Provider contracting, provider relations and network development operations in a health plan
    • Provider portals
  • Enrollment / Billing
    • Member enrollment, premium billing
    • Member portals
  • Clinical
    • Medical cost containment, medical policy
    • clinical business processes
    • Utilization management, disease management, case management
    • EMR
  • Payment Integrity
    • Claims Editing
    • Enrollment Integrity/Coordination of Benefits
    • FWA
    • Overpayment Identification
    • Claims auditing
    • Health care Subrogation / Third Party Liability

Required Qualifications:
  • 1+ years of experience working in an operations role at a health plan
  • 2+ years of experience working in a management consulting organization (big 4 preferred)
  • 3+ years of Healthcare experience in any of the following:
    • Government Programs, PBM Clinical Health Management, Core, Program Management, Product Management, or Network Management
  • 1+ years of experience in one or more of the following:
    • Operational business process improvement, business process analysis, benchmark analysis or workflow analysis
  • 1+ years of experience with client relationship management and expanding sales opportunities beyond current engagement
  • Ability to travel 80%** (see note below)
  • Proven experience in data analysis and financial analysis
  • Proven problem solving skills (identification of issue, causes, solution, implementation plan)
  • Project coordination and management - strong project tracking, presentation and reporting skills
  • Experience writing and developing client facing materials in Microsoft Word, Visio, PowerPoint, Excel, Project
**Travel is required for this role and typically our associates travel Monday through Thursday.  Location of residence is flexible for this role; however, travel is a requirement.**
Preferred Qualifications:
  • Bachelor's degree
  • Strong work ethic and desire to help clients improve their businesses

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)



*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy

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.



Job Keywords: optuminsightconsulting

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