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Commercial Implementation Eligibility Lead - Telecommute

Company: UnitedHealth Group
Location: San Diego
Posted on: September 23, 2022

Job Description:

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)



At OptumCare, we seek to enhance the performance of the health care system and improve the overall health and well-being of the people we serve and their communities. -We are building OptumCare's Foundation for the Future - Building a turnkey, physician and consumer centric operating and technology platform that delivers the highest quality, best outcomes, highest satisfaction experience and lowest cost national ambulatory network. -When you join us as a Sr Business Analyst - Eligibility, you will have the opportunity to be a part of our Foundation for the Future.
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The Commercial Implementation Eligibility Lead will participate on a team to implement new business and expansions for OptumCare. -Reporting to the Implementation Director, you will act as a Business Subject Matter Expert to the IT team, representing the voice of the business by performing analysis and capturing business requirements. You will present to internal and external leadership on the status of all member centric tasks required for a claim to process and a member to have access to care. -



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



Primary Responsibilities:


  • Acts as the subject matter expert representing the business with the ability to clarify requirements, prioritize work, and drive deliverables for commercial product implementations
  • Work with the Payor to inform requirements for receiving data. Coordinate all deliverables from the Payor
  • Participates in solution analysis and design meetings
  • Own membership data validation and audits for go-live readiness
  • Owns the project plan and updates required for loading/maintaining commercial member data
  • Supports implementation user acceptance testing needs
  • Ensure eligibility operation readiness for commercial members
  • Works closely with implementation production teams to coordinate/collaborate on goals and requirements -
  • Facilitates access and functionality needs of supporting member source of truth portal/tool needs
  • Communicates and reports out downstream impacts cross-functionally
  • Supports system to system member fallout monitoring




    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 -
    • 5+ years of experience working with end to end Commercial Member eligibility / enrollment management activities: oversight of member eligibility loads, eligibility roster reconciliation, change file vs full file processing, downstream member data feeds to other systems
    • Direct experience working with employer groups and/or health plans for managing their eligibility data used for claim payment systems
    • Proven experience presenting to executive leadership
    • Proven experience working with IT to load member data onto a claims platform
    • Proven experience with process mapping, and documentation writing
    • Proven experience with project oversight and management: planning, roadmap, timeline, risk management, issue resolution
    • Experience working with cross-functional teams
    • Testing and use case development experience




      Preferred Qualifications:


      • Implementation Lead/Manager or Business Analysis experience
      • Experience working in Agile environment
      • Experience working on a systems migration project
      • Experience working in member Eligibility and Enrollment systems: Facets
      • Experience working in a delegation environment
      • Experience in the California commercial and government market place -
      • Must be self-motivated and able to work with little direct supervision and drive results with disciplined follow-though
      • Solid strategic thinking and business acumen with the ability to define an action plan and delivery path
      • Experience driving decision-making with teams and management
      • Experience working with cross-functional teams
      • Ability to effectively break down barriers to maintain progress on deliverables
      • Diplomatic with effective negotiation and conflict resolution skills
      • Ability to make quick decisions when clarification or modification is needed
      • Self-directed and able to drive deliverables to completion with minimal oversight
      • Detail oriented and -organized
      • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation.



        To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment


        Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)



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



        Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $82,100 to $146,900. The salary range for Connecticut / Nevada residents is $90,500 to $161,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.




        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-frepe worklace. Candidates are required to pass a drug test before beginning employment.

Keywords: UnitedHealth Group, San Diego , Commercial Implementation Eligibility Lead - Telecommute, Other , San Diego, California

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