Senior Provider Relations Advocate - Remote

UnitedHealth Group•Eden Prairie, MN

2d•$72,800 - $130,000•Remote

About The Position

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.

Requirements

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 skills
Demonstrated excellent verbal and written communication skills
Demonstrated ability to manage multiple priorities in a fast-paced environment
Demonstrated ability to influence outcomes through collaboration and relationship building
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

Nice To Haves

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

Responsibilities

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 concerns, Provider and member data issues, Eligibility concerns, Provider 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
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
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
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
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