Bring us your experience, your head for strategy, your strength with relationships and your eye for opportunity. In return we offer an unmatched place to grow and develop your career among a richly diverse group of businesses driven by the power and stability of a leading health care organization. Come help us heal and strengthen the health care system as you do your life's best work.(sm) The Recovery Resolutions FWAE Regulatory Affairs Advocate receives, documents, processes and resolves provider, physician and / or member grievances. This individual will serve as a primary resource to senior management, plan sponsors, enrollees, and regulatory agencies across all states in resolution of oral and written complaints and appeals. Primary Responsibilities: Research and resolve customer complaints and complex or multi-issue appeals submitted by consumers and physicians / providers to UnitedHealth Group executives, state attorney generals, and other regulatory agenciesProvide expert knowledge of appeals process and assess appeals status of complaintsConduct root cause analysis by identifying potential compliance, process, or systemic breakdowns and communicate findings to managementAssure member complaints / grievances and appeals and provider appeals are resolved within regulatory timeframesCollaborate with internal departments to resolve member complaints / grievances according to regulatory timelinesPrepare material discussed at member / provider appeal committee meetingsCorrespond both verbal and written regarding member grievance and appeals and provider appealsDevelop effective working relationships with the applicable regulatory agencies and plan personnelAssist in preparation of summary grievance reports to regulatory agencies
Required Qualifications: Bachelor's degree or equivalent experience 3+ years of customer service experience in a healthcare environment 2 + years' experience working with Recovery Resolution FWAE Intermediate level of proficiency with MS Word, Excel, and Access Strong communications skills, verbally and in writingPreferred Qualifications: Experience with all claims platforms, (UNET, COSMOS, FACETS, etc.) 2 years' experience with TIPS Historical, PICTS, Detects, Fastrieve, SAS Reporting 3+ years of project management experienceCareers 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) 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: FWAE, Fraud, Waste, Abuse, Recovery Resolution, INET, COSMOS, FACETS, TIPS Historical, PICTS, Detects, Fastrieve, SAS, Eden Prairie, MN, Minnesota, Irvine, CA, California, Cypress, Tucson, AZ, Arizona, Overland Park, KS, Kansas
Internal Number: 752323
About UnitedHealth Group
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.