Senior Provider Relations Advocate - Remote

Posted 3 days ago

unitedhealthcare at homeEden Prairie (MN)

Patient Representatives Pharmacy Benefit Management and Other Third Party Administration of Insurance and Pension Funds

SENIORITY

Senior

SALARY

$72,800 - $130,000 annually

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About the role

Senior Provider Relations Advocate For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together. The Senior Provider Relations Advocate serves as a subject matter expert responsible for managing complex provider, claims, payment, authorization, access, data, and operational escalations. This role acts as a liaison between providers, internal business partners, payer organizations, and leadership to ensure timely resolution of issues while improving the overall provider experience. Working with minimal supervision, the Senior Provider Relations Advocate independently researches, analyzes, and resolves complex and often ambiguous issues that require cross-functional collaboration. This position plays a critical role in identifying root causes, driving accountability, escalating barriers, and recommending process improvements that reduce operational friction and improve resolution outcomes. The ideal candidate possesses solid analytical, problem-solving, and relationship-management skills. A claims background is solidly preferred, as a significant portion of the role involves researching and resolving escalated claims, payment, and reimbursement issues. The person hired into this role will need to be able to work Central Time Zone hours, generally 8am - 5pm, with some flexibility in schedule allowed. You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

Issue Escalation Management Manage end-to-end resolution of complex provider and operational escalations
Assess issue severity, business impact, urgency, and required actions
Investigate and resolve escalated issues involving: Claims and payment discrepancies
Prior authorization concernsProvider and member data issues
Eligibility concernsProvider incentive payment disputes
Access and technology-related issues
Operational and service-related concerns
Facilitate timely resolution through effective coordination across multiple business areas
Maintain ownership and accountability throughout the issue lifecycle from intake through closure
Claims and Payment Resolution Research complex claims and payment inquiries utilizing multiple systems and data sources
Analyze claim adjudication outcomes, payment methodologies, remittance information, and provider reimbursement concerns
Identify root causes impacting claims processing and payment accuracy
Partner with claims operations, payment integrity, health plans, network management, and other stakeholders to resolve issues
Educate providers and internal partners on claims processes, policies, and resolution pathways
Research and Root Cause Analysis Conduct detailed investigations into complex operational and provider issues
Analyze trends, recurring problems, and systemic barriers affecting provider satisfaction and operational performance
Identify opportunities for sustainable corrective actions
Develop recommendations that improve processes, workflows, and customer experience
Translate complex findings into actionable solutions for stakeholders and leadership
Provider Advocacy and Relationship Management Serve as a trusted advocate for providers while balancing organizational policies and business objectives
Assess and interpret provider needs and requirements
Communicate complex information in a clear, professional, and customer-focused manner
Build and maintain positive relationships with providers and internal stakeholders
Cross-Functional Collaboration Partner with Operations, Network Management, Claims, Payment Integrity, Contracting, Client Services, Quality, Clinical Operations, Technology, and Payer organizations
Escalate systemic issues and risks to leadership as appropriate

You'll 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 provide development for other roles you may be interested in.

Required Qualifications:

High school diploma or equivalent 3+ years of experience in healthcare operations, provider relations, claims, network management, customer service, or related healthcare field
Experience researching and resolving complex provider issues
Facets claim system experience
Microsoft Office, including Excel experience with pivot tables
Demonstrated solid problem-solving, analytical, and critical thinking skillsDemonstrated excellent verbal and written communication skillsDemonstrated ability to manage multiple priorities in a fast-paced environment
Demonstrated ability to influence outcomes through collaboration and relationship building

Preferred Qualifications:

Experience with provider reimbursement, payment integrity, claims adjudication, or prior authorization workflows
Experience managing escalated provider issues
Experience conducting root cause analysis and implementing process improvements
Experience working with cross-functional operational and technology teams
Claims processing, claims operations, or claims resolution experience
Knowledge of healthcare provider operations and managed care environments
Knowledge, Skills, and Abilities
Advanced claims and payment analysis skills
Knowledge of healthcare reimbursement methodologies and claims processes
Solid investigation and research capabilities
Root cause analysis and problem-resolution expertise
Ability to work independently with minimal direction
Solid organizational and prioritization skills
Ability to effectively navigate ambiguous and complex situations
Relationship management and conflict-resolution skills

Proficiency with Microsoft Office applications and healthcare operational systems*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter PolicyPay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. 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. OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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