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***Sr Healthcare Consultant, Health Plan Payer / Provider Operations

UnitedHealth Group

Eden Prairie, MN
Job Code:
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Job Details

***Sr Healthcare Consultant, Health Plan Payer / Provider Operations(Job Number:729495)

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)


Primary Responsibilities:

We are seeking candidates who have deep domain expertise and previous management consulting experience in one or more of the following areas of Health Plan Operations:

  • Health Plan Operations
    • Government Programs - Medicaid, Medicare Advantage, and Medicare Part D
    • PBM - Third party administrator of prescription drug programs, pharmacy, administration of claims and benefits, drug utilization, distribution, disease management, and volume purchasing
    • Clinical - Payer disease and utilization management, HIN, ICD10 business processes, technology assessment, planning, remediation and compliance
    • Core Admin & Project Management  - Cost containment, process improvement, provider contracting, project management and Health Care Reform
    • Product Development - Market assessments and sizing competitive intelligence, sales management and distribution, network development, and vertical integration

In addition, candidates must have domain expertise and previous management consulting experience in one or more of the following additional areas:

  • Payment Integrity
    • Claims Editing
    • Enrollment Integrity/Coordination of Benefits
    • FWA
    • Overpayment Identification
    • Claims auditing
    • Health care Subrogation / Third Party Liability
  • 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

Job Bus Advisory & Tech Cnsltng
Primary Location US-MN-Eden Prairie
Other Location United States
Organization Ops Consulting
Schedule Full-time
Number of Openings 1
Apply on the Company Site

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.

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