Sign In
 [New User? Sign Up]
Mobile Version

***Healthcare Consultant, Health Plan Payer / Provider Operations - Telecommute

UnitedHealth Group

Minnetonka, MN
Job Code:
Apply on the Company Site
  • Save Ad
  • Email Friend
  • Print
  • Research Salary

Job Details

760200 Healthcare Consultant Health Plan Payer Provider Operations Telecommute

***Healthcare Consultant, Health Plan Payer / Provider Operations - Telecommute (760200)

Position Description

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 care provider’s operational interactions with health plans, 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 drivers

 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

In addition, candidates must have 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


  • 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:

  • 3+ 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)
  • 5+ years of Healthcare experience in any of the following:
    • Government Programs, PBM, Clinical Health Management, Core Administer Delivery, Program Management, Product Management, or Network Management
  • 2+ 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)
  • 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 obtained
  • PMO methodology experience
  • 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: consultant, consulting, healthcare, healthplan, payer, operations, management, travel, telecommute, telecommuter, telecommuting, remote, work from home, OptumConsulting

Job Details

  • Contest Number760200
  • Job Title***Healthcare Consultant, Health Plan Payer / Provider Operations - Telecommute
  • Job FamilyOptumInsight Consulting
  • Business SegmentOptumInsight

Job Location Information

  • Minnetonka, MN
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelYes, 75 % of the Time
  • Telecommuter PositionYes
  • Overtime StatusExempt

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

Powered ByLogo

Featured Jobs[ View All ]

Featured Employers [ View All ]