We have an opportunity for a Senior Clinical Configuration Analyst with experience in building and configuring claims within a new business configurable system (similar to Facets, HealthRules or QNXT). In this role you will design, build, and validate across functional areas, for adjudication schedules, provider certification and accreditation, remark and deny reason codes, claim audits, delegation and prompt pay and more. You will support complex system configuration changes and new configuration requirements, including configuration analysis, design, build and testing. Duties include troubleshooting and fixing system configuration errors, performing investigations and root cause analysis of trouble tickets, and ensuring day to day issues are identified and appropriately addressed.
This role is office based in Eden Prairie, MN. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges if you are willing and able to travel to Minnesota, 25% of the time, for meetings and training.
- Configuration Design:
- Analyze products, contracts and pricing, design/configure claim rules and clinical rules, conduct configuration validation, and perform configuration peer review
- Communicate design to all stakeholders at varying levels of the organization
- Present and evaluate design solutions objectively and facilitate conflict resolution
- Define, use and communicate design patterns and best practices in service-oriented analysis, design and development
- Configuration Build & Maintenance:
- Configure new business, including products / benefits, clinical, claims and/or capitation, within a health plan configuration system (e.g. Facets)
- Update source-to-target data mapping and/or data transformation rules
- Configuration Quality Assurance:
- Participate in quality assurance and testing within health plan configuration system (e.g. Facets) to ensure configuration is ready for implementation
- Collaborate with quality assurance team to ensure testing efforts align with system deliveries and business processes
- Recommend strategies to improve service development life cycle and governance processes
- Understand and use enterprise service and data models
- Bachelor’s degree or equivalent experience
- 3+ years of Benefit, Claim and/or Enrollment configuration experience
- 3+ years of healthcare and/or health insurance experience
- 3+ years of experience identifying patterns within quantitative data, drawing conclusions and recommending solutions and approaches; skilled with end-to-end issue resolution
- Intermediate or greater level of proficiency with Microsoft Excel and Word
- 25% travel
- Product, Benefit, Claim and/or clinical research and analysis knowledge
- Large-scale platform implementation or migration experience
- Knowledge of data structures within a health plan configuration system (e.g. Facets or Cirrus)
- Advanced Excel and Access
- Ability to clearly articulate (both verbal and written) project status and issues management
- Excellent oral and written communication skills, interpersonal skills and organizational abilities are essential
- Ability to work effectively with minor supervision
- Ability to manage multiple assignments while maintaining quality standards and meeting assigned deadlines
UnitedHealth Group is a Fortune 6 company that offers a broad spectrum of products and services dedicated to helping people live healthier lives and making health care work better for everyone. Be part of the team. Join us and start doing your life's best work.SM
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can 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: Configuration Analyst, Eden Prairie, MN, Minnesota, telecommute, telecommuter