Claims Process and Business Consultant

Job title: Claims Process and Business Consultant

Company: UnitedHealth Group


Job description: Claims Process and Business Consultant – Letterkenny – HybridOptum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.About the Role:As a Fortune 5 business, we’re one of the world’s leading healthcare companies. There are no limits here on the resources you’ll have or the challenges you’ll encounter.We have been supporting global healthcare systems from Ireland and the UK for more than 20 years, building a dynamic and diverse team of more than 2,100 talented individuals. With a continued record of growth and stability, we’re on the constant lookout for fresh talent to join our expanding teams.The purpose of the Claims Process and Business Consultant is to be the primary point of contact for system related issues. They will be expected to document processes impacted by the system, identify potential process improvements, and assist with system training. They will also coordinate with developers to root cause system issues, develop requirements for system enhancements, and maintain an enhancement pipeline. They are to build a network amongst internal business partners to validate the processes and procedures that are aligned with the requirements of the system.Success in this role will require ensuring a seamless process is in place regardless of internal claims engines. This position will utilize their analytical skills, as well as knowledge of the business and its processes to manage this operational support function.Working Schedule:This is a full-time position, Monday – Friday with standard working hoursCareers with Optum offer flexible work arrangements and individuals who live and work in the Republic of Ireland will have the opportunity to split their monthly work hours between our Letterkenny Office and telecommuting from a home-based office in a hybrid work model.Primary Responsibilities of the Claims Process and Business Consultant:

• Workflow Tool (REVA and ATS)

• Collaborate with the requestor to validate enhancement requirements and engage in discussions with the development team.
• Evaluate business requirements to assess system/process optimization and identify potential issues and opportunities.
• Identify root causes of issues and enhancements to improve processes by updating SOPs and training as needed
• Create and maintain REVA/ATS user profiles and group configurations to align with business needs.
• Collaborate with IT developers to maintain BRM tables to align with business needs.
• Participate in daily grooming calls to assist with workflow tool configuration using knowledge of claims systems and routing tools.
• Provide backup support for REVA/ATS access approval during the leader’s PTO.

• Documentation:

• Document requirements for workflow tool enhancements, infrastructure needs, and SOP processes.
• Review and update existing documents for formatting, issues, and process improvements.
• Update SOP documents based on deployment results.
• Contribute to governance development for SOP documentation and process changes, and present updates to the governance board.

• Testing & Training:

• Participate in bi-weekly ATS demo calls, complete deployment testing, and test the User Stories for business user acceptance.
• Identify and update necessary documents, and review with analysts.
• Provide training to analysts through in-person or recorded classes.
• After training, validate understanding through quality control or questionnaires.
• Will be responsible for doing a determined number of cases to remain fresh with what is going on with the business.

• Process Improvement & Analysis:

• Participate in root cause analysis to identify process gaps in workflow tool enhancements and initiate improvements.
• Develop and recommend solutions to business process problems and evaluate their effectiveness.
• Continuously improve processes and documentation to enhance department metrics.

• Operational Efficiency & Project Support:

• Apply system expertise, process analysis, and business knowledge to projects establishing end-to-end infrastructure and processes

• Future State Development:

• Seek innovations within the Issue Resolution team to advance the business. Participate in monthly innovation calls to support business-submitted ideas.

• Personal and Team Development

• Identify a development area to improve, apply what you learn to your work, and engage in projects/tasks to enhance the skill.
• Participate in team-building activities to strengthen our team and expand knowledge.

• SharePoint

• Maintain SharePoint requests and standardization across all Issue Resolution teams, and provide backup support as needed.

• Governance Lead (Root Cause and Documentation)

• The lead is responsible for ensuring that the committee’s activities align with the organization’s strategic goals. This includes setting agendas, prioritizing initiatives, and ensuring that governance practices support operational and compliance objectives.
• A key function is to oversee adherence to the policies and procedures determines by the committee are complying
• The lead typically chairs meetings, ensures accurate documentation of discussions and decisions, and oversees the distribution of minutes.

You will be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role, as well as providing development for other roles you may be interested in.Required Qualifications of the Claims Process and Business Consultant:

• Claims experience
• Experience in a combination of issue resolution
• Experience analyzing and solving issues in a professional environment
• Proficient with Microsoft Excel and PowerPoint Applications
• Demonstrated ability to handle non-standard processes

Preferred Qualifications of the Claims Process and Business Consultant:

• Experience in the Health Care industry
• High proficiency presenting (verbal and written) complex operational information
• Bias for action
• Experience in claims adjudication
• Knowledge of Value Based Contracting or Capitated Delegated Division of Responsibility business models
• Appeals/grievance or claims rework experience
• Experience with provider practices, billings, and revenue cycles
• Proficient with Microsoft Excel and PowerPoint Applications

Soft Skills:

• Excellent verbal and written communication skills, internal and external executive level
• High proficiency with relationship skills
• High proficiency in analytical skills
• Intellectually curious

Please note you must currently be eligible to work and remain indefinitely without any restrictions in the country to which you are making an application. Proof will be required to support your application.For more information on our Internal Job Posting Policy, click .All telecommuters will be required to adhere to the UnitedHealth Group’s Telecommuter Policy.At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.Diversity creates a healthier atmosphere: Optum is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to gender, civil status, family status, sexual orientation, disability, religion, age, race, and membership of the Traveler community, or any other characteristic protected by law. Optum is a drug-free workplace. © 2024 Optum Services (Ireland) Limited. All rights reserved.#RPO

Expected salary:

Location: United Kingdom – Letterkenny, Co Donegal

Job date: Sat, 31 May 2025 22:59:08 GMT

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