Provider Relations Advocate - Remote within the Philadelphia Metro Area

UnitedHealth Group•Philadelphia, PA

1d•$60,200 - $107,400•Remote

About The Position

Optum 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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The more you do, the more you learn. As you learn, you'll discover new opportunities to grow, make an impact, and bring your best every day. As a Provider Relations Advocate with UnitedHealth Group, you'll play a critical role in strengthening provider partnerships and improving the health care experience for providers and members alike. We're building solider, more effective provider networks every day. In this role, you'll serve as a trusted resource and advocate for providers, using your customer service skills, managed care knowledge, and claims expertise to help resolve issues and improve the provider experience. You'll have the opportunity to deepen your understanding of provider relations, network operations, claims processes, and health plan administration while gaining exposure to a broad range of business partners and functions across the organization. In this role, you will serve as a liaison between the health plan and provider community, leveraging your expertise in managed care operations, provider servicing, claims resolution, reimbursement processes, and network management. The ideal candidate has experience working for a health insurance carrier, managed care organization (MCO), or within a payer operations environment and understands the challenges providers face when navigating health plan processes. What Makes This Role Unique This individual contributor role is ideal for early to mid-career professionals who have worked on the payer side of healthcare and enjoy building relationships while solving operational challenges. You'll collaborate with providers and internal stakeholders to improve processes, resolve complex issues, and enhance overall provider satisfaction. If you are located within Philadelphia Metro Area, you will have the flexibility to work remotely as you take on some tough challenges. 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.

Requirements

High school education or equivalent experience
3+ years of experience working for a health insurance carrier, managed care organization, or payer operations team
1+ years of provider relations, provider services, network management, or provider network experience
Experience resolving provider issues involving claims adjudication, reimbursement, eligibility, prior authorization, credentialing, or enrollment processes
Experience collaborating with cross-functional operational teams including claims, network, provider services, and customer operations
Intermediate proficiency with Microsoft Word, Excel, and PowerPoint

Nice To Haves

3+ years of provider relations, provider account management, or provider service experience
Experience working for a health insurance carrier, managed care organization (MCO), or third-party administrator (TPA)
Experience supporting provider networks and provider-facing operational initiatives
Experience with Medicare and Medicaid regulatory requirements
Experience analyzing provider trends and recommending operational improvements
Solid understanding of claims adjudication, reimbursement methodologies, provider appeals, and payment resolution processes
Knowledge of provider contracting, credentialing, and network development functions
Familiarity with provider data management, eligibility systems, and authorization processes

Responsibilities

Serve as a liaison between the health plan and provider community.
Leverage expertise in managed care operations, provider servicing, claims resolution, reimbursement processes, and network management.
Collaborate with providers and internal stakeholders to improve processes, resolve complex issues, and enhance overall provider satisfaction.