Claims Provider Service Advocate
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The Claims Provider Service Advocate will serve as a subject matter expert for Long-Term Services and Support (LTSS) claims-related inquiries and escalations. This role is responsible for investigating, recovering, and resolving a broad range of LTSS claim issues, ensuring alignment with contractual, reimbursement, and compliance standards. The individual will analyze claim trends, prepare reports, and provide proactive support to the LTSS Provider Services and Relations Team.
This position requires solid analytical thinking, initiative, and the ability to work independently across multiple systems and applications. The ideal candidate is a self-motivated problem solver with a high attention to detail and a commitment to timely, high-quality service delivery. The Claims Provider Service Advocate will also facilitate quarterly claims clinics for providers to support education and prevention.
If you are located in Tennessee, you will have the flexibility to work remotely* as you take on some tough challenges.
Primary Responsibilities:
- Investigate and resolve a variety of LTSS claim issues and escalations with accuracy and urgency
- Provide claims expertise and support to the LTSS Provider Services and Relations Team
- Research and analyze claims trends; compile reports and share findings with leadership
- Ensure adherence to reimbursement policies, contract terms, and state compliance requirements
- Support recovery and resolution efforts for the health plan
- Handle high-level provider escalations as needed
- Facilitate and lead quarterly claims clinics with providers to identify areas for improvement and provide education
- Work across multiple systems and functions daily, including CSP Facets and related tools
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:
- 4+ years of experience in claims recovery and resolution
- Intermediate level of proficiency in CSP Facets
- Intermediate level of proficiency in Windows PC applications and the ability to learn new complex systems
- Reside in Tennessee
- Ability to travel to TN up to 10% for in-market team meetings as necessary
Preferred Qualifications:
- Experience using: Maces, OIT, ORBIT Business Objects Production, IMPACT, Facets, EchoUi, Provider Information Queues (PIQ)
- Experience supporting or collaboration with provider relations or external stakeholder teams
- Familiarity of LTSS programs
Soft Skills:
- Effective written and verbal communication and presentation skills
- Ability to balance multiple high priority projects and meet quick deadlines
- Proven solid analytical and problem-solving skills
- Proven self-motivated with the ability to work independently and proactively
*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Pay 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). The salary for this role will range from $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.
UnitedHealth Group 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.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
