Provider Network Relations Representative – Remote Nationwide

UnitedHealth Group
Published
April 4, 2021
Location
Atlanta, GA
Category
Job Type

Description

This is an opportunity that's all about where you've been. Your experience. Your potential. Your skills. All pretty strong up to now. It's also an opportunity about what's ahead. Because on the team at UnitedHealth Group, your potential and your impact can be career changing. We're driving ever higher levels of sophistication in how provider networks are formed and operate. The goal is to improve quality of service while exploring new ways to manage costs. Here's where you come in. You'll use your knowledge of insurance claims and customer service to help create strong relationships with the providers in our networks. As you do, you'll discover the resources, backing and opportunities that you'd expect from a Fortune 7 leader.

Positions in this function are responsible for the successful program network design, compliance with network requirements, network assessment and selection, and network program/product implementation. This includes performing network analysis and strategy development and implementation. Obtains data, verifies validity of data, and analyzes data as required for network design and maintenance. Analyzes network availability and access.

May make recommendations regarding use, expansion, selection of networks for various products based on that analysis.

You’ll enjoy the flexibility to telecommute* from within the U.S. as you take on some tough challenges.
 

Primary Responsibilities:

  • Assist with setting up pharmacy network structure in RxClaim for New Business and/or Client Renewals.
  • Create documentation for standard operating procedures (SOP)
  • Make decisions guided by policies, procedures, and business plan
  • Provide Client support on pharmacy claim investigations
  • Audit work of others to identify and process / coordinate correction of loading errors
  • Recommend methods to improve processes used by department.
  • Serve as a resource to others, including training of new employees        

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 GED
  • 3+ years of work experience in managed care or PBM experience (experience can include credentialing providers, provider relations, provider administration)
  • 1+ years of experience working with RxClaim
  • Demonstrated prioritization / organizational skills and attention to detail
  • Demonstrated interpersonal and communication skills including telephone / email etiquette
  • Basic level of proficiency with RxClaim, MS Excel and MS Word
  • If you need to enter a work site for any reason, you will be required to screen for symptoms using the ProtectWell mobile app, Interactive Voice Response (i.e., entering your symptoms via phone system) or a similar UnitedHealth Group-approved symptom screener. Employees must comply with any state and local masking orders. In addition, when in a UnitedHealth Group building, employees are expected to wear a mask in areas where physical distancing cannot be attained

Preferred Qualifications: 

  • Undergraduate degree
  • Certified Pharmacy Tech (CPhT)
  • Claims processing experience
  • Knowledge of pharmacy pricing aspects
  • Knowledge of Provider networks and/or affiliations

UnitedHealth Group is an essential business. The health and safety of our team members is our highest priority, so we are taking a science driven approach to slowly welcome and transition some of our workforce back to the office with many safety protocols in place. We continue to monitor and assess before we confirm the return of each wave, paying specific attention to geography-specific trends. At this time, 90% of our non-clinical workforce transitioned to a work at home (remote) status.  We have taken steps to ensure the safety of our 325,000 team members and their families, providing them with resources and support as they continue to serve the members, patients and customers who depend on us.

You can learn more about all we are doing to fight COVID-19 and support impacted communities at: click here.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Colorado Residents Only: The hourly range for Colorado residents is $20.77 to $36.88. Pay is based on several factors including but not limited to education, work experience, certifications, etc. As of the date of this posting, In addition to your salary,  UHG offers the following benefits for this position, subject to applicable eligibility requirements: Health, dental, and vision plans; wellness program; flexible spending accounts; paid parking or public transportation costs; 401(k) retirement plan; employee stock purchase plan; life insurance, short-term disability insurance, and long-term disability insurance; business travel accident insurance; Employee Assistance Program; PTO; and employee-paid critical illness and accident insurance.

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.

Keywords: UnitedHealth Group; Optum, Associate Provider Service Representative, Word, Excel, Managed Care, Medical Insurance, remote, PBM, RxClaims, work at home, work from home, WAH, WFH, remote, telecommute, hiring immediately, #RPO

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