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

UnitedHealth Group

Eden Prairie, MN
Job Code:
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***Sr Healthcare Consultant - Health Plan Payer/Provider Operations - Telecommute(Job Number:694727)

What can YOU do with the right information? At OptumInsight, the possibilities and the impact are limitless. You'll be empowered to ask more questions, develop better solutions and help make the health care system greater than ever. It's always fresh. It's always exciting.

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 consulting expertise in one or more of the following areas:

  • 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
  • Payment Integrity
    • Claims Editing
    • Enrollment Integrity/Coordination of Benefits
    • FWA
    • Overpayment Identification
    • Claims auditing
    • Health care Subrogation / Third Party Liability
  • Claims Configuration
    • Lead configuration activities for a core claims administrative system (IKA, QNXT, FACETS, Health Rules, etc.) based on expertise in one or more functional areas (e.g., Product, Provider, Member, Finance)
    • Lead configuration design activities including direct management of project team members
    • Participate in design sessions
    • Participate in test development and execution activities
    • Provide configuration thought leadership to organization
    • Ensure that all configuration documentation is prepared, reviewed, and approved


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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