Senior Provider Data Analyst & Resolution Specialist - Remote

UnitedHealth Group•San Diego, CA

2d•$29 - $52•Hybrid

About The Position

Optum, part of UnitedHealth Group, is hiring for a critical, budgeted replacement position funded by an ASO contract with the County of San Diego. The role supports the Fee for Service provider network managed on the County’s behalf. It processes provider applications and contracts and completes provider credentialing and re-credentialing. The position manages provider networks supporting hospital, Fee for Service (FFS), and TERM services, and may work with Off Panel and Out of Network providers, Skilled Nursing Facilities, hospitals—including San Diego County Psychiatric Hospital and Edgemoor Hospital—and other medical professionals. The Senior Provider Data Analyst & Resolution Specialist is responsible for provider relations and service interactions, provider data integrity, credentialing and contracting support, and investigating and resolving operational and claims issues. The role analyzes provider data and performance, supports provider network strategies, identifies network composition or service gaps, and helps remediate operational shortfalls. It also responds to provider inquiries, supports provider education and training, maintains accurate provider records across multiple systems, and collaborates with internal teams, County partners, providers, and other stakeholders. This is a hybrid-remote role for employees residing in San Diego, California, requiring two onsite days at 3131 Camino del Rio North, Suite 700, San Diego, CA 92108. The schedule is Monday through Friday, 8:30 a.m. to 5 p.m. Pacific Time. The hourly pay range is $29–$52 based on full-time employment. Remote employees must follow UnitedHealth Group’s Telecommuter Policy. Candidates must pass a drug test before employment.

Requirements

At least 3 years of experience in healthcare analytics, provider data management, provider relations, claims operations, network management, or related healthcare operations.
Experience investigating and resolving complex provider issues involving claims, contracting, credentialing, reimbursement, and provider data.
Experience analyzing healthcare data and translating findings into actionable business recommendations.
Experience working with provider databases and enterprise platforms such as TRES, SmartCare, SharePoint, SQL Server, or comparable systems.
Advanced analytical and investigative skills, including interpreting complex datasets, identifying trends, conducting root cause analyses, and recommending sustainable solutions.
Knowledge of healthcare data flows, system dependencies, and impacts on provider operations and claims processing.
Ability to pass a drug test before beginning employment.
Remote employees must adhere to UnitedHealth Group’s Telecommuter Policy.

Nice To Haves

Solid problem-solving, analytical, written, and verbal communication skills.
Ability to communicate complex data findings, operational impacts, and recommendations to technical and non-technical audiences.
Ability to work independently while collaborating effectively with cross-functional teams.
Project management, facilitation, and stakeholder engagement experience.
Ability to manage multiple priorities, investigations, and projects while meeting established deadlines.
Ability to influence process improvements and drive issue resolution without direct authority.
Commitment to improving provider satisfaction, reducing provider friction, and enhancing provider network performance.

Responsibilities

Manage provider interactions and support ease of use of the provider portal, including future service enhancements.
Support the development and delivery of external provider education and training programs.
Assist the Manager and Leadership in updating and developing provider data, workflows, systems, and processes.
Support credentialing, re-credentialing, enrollment, and contracting processes, including Letters of Agreement, in compliance with NCQA or County standards.
Order and support Primary Source Verification for providers.
Maintain current provider credentialing documentation, including DEA registration, clinical licenses, board certifications, and professional liability insurance.
Process applications and supporting documentation to ensure providers meet credentialing criteria for inclusion in FFS and TERM networks.
Collaborate with cross-functional teams to execute site-wide processes.
Respond to provider requests and inquiries by email, phone, mail, and fax, directing them to appropriate internal or external resources.
Build and nurture positive relationships among the health plan, providers, and practice managers.
Contribute to development and management of provider network strategies.
Identify gaps in provider network composition and services to help prioritize contracting needs.
Identify and remediate operational shortfalls and research and remediate claims.
Follow up with providers to obtain supporting documents and attestations required for contracting and continued network participation.
Ensure provider and group system setup forms are completed accurately and submitted to the appropriate internal departments.
Plan, prioritize, organize, and complete tasks to meet established goals and deadlines.
Design and deliver effective training aligned with departmental goals and team-member needs.
Develop report templates and generate reports to support provider data analysis.
Participate in meetings supporting departmental and cross-functional goals and objectives.
Accurately enter and update provider data across databases used for directories, payments, mailing, and reporting.
Maintain organized provider files for access by staff, leadership, and other departments.
Conduct peer reviews of provider files to ensure accuracy and current supporting documents.
Document provider communications in designated systems and verify and update provider information to maintain database integrity.
Support the Manager and Leadership in preparing for the annual audit.
Perform additional duties as assigned by the Manager.
Investigate and resolve complex provider issues involving claims, contracting, credentialing, reimbursement, and provider data.
Analyze healthcare data, identify trends and root causes, and translate findings into actionable business recommendations.
Support end-to-end provider claims, call quality, and network support.

Benefits

Paid Time Off accrued beginning with the first pay period
8 paid holidays
Medical plan options
Health Spending Account or Health Savings Account participation
Dental insurance
Vision insurance
Life and AD&D insurance
Short-term disability coverage
Long-term disability coverage
401(k) savings plan
Employee Stock Purchase Plan
Education reimbursement
Employee discounts
Employee Assistance Program
Employee Referral Bonus Program
Voluntary benefits, including pet insurance, legal insurance, and long-term care insurance
Performance rewards
Incentive and recognition programs
401(k) contribution
Comprehensive benefit program