Provide an exceptional customer service experience when responding to and resolving customer service inquires and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility and claims, financial spending accounts and correspondence Research complex issues (such as Medical, Dental, Flex Spending, Pharmacy, etc.) across multiple da

Participate in a 24 month Rotational Program that will provide a structured curriculum and on the job sessions that will expose you to broad skills, tools, and functional departments within the Sales & Distribution Organization. Along with training and a core role within the Producer Helpdesk Sales Support organization, you will also experience two, six month rotations fu

Investigations Refine investigation protocols, documentation standards, and policy interpretation guidelines in partnership with Employment Law and ER Case Management leadership Conduct thorough, timely, objective, efficient and equitable investigations into employee complaints and allegations of misconduct, in line with agreed upon investigation framework and applicable

Develop, lead and execute category management, sourcing/RFx, vendor management and financial analysis efforts across the Enterprise in human capital, legal services and other indirect spend categories as assigned Review, develop, redline, and negotiate complex third party vendor contracts, including Master Services Agreements (MSAs), Statements of Work (SOWs), Non Disclos

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, c

Support network pricing strategies and tactics, in collaboration with local network field leaders and network managers Analyze financial impact of provider contracts (e.g., facility; physician; ancillary) Analyze payment appendices to provide options for various contracting approaches and methodologies Communicate results of financial impact and analysis to appropriate st

Advise UnitedHealthcare's Medicare Part D business Counsel on Part D product, clinical (Pharmaceutical & Therapeutic Committee, formulary development), marketing, and regulatory requirements Provide strategic counsel to the business on the Pharmacy Benefit Management (PBM) Agreements, benefit implementation and management, and compliance oversight and monitoring Provide c

Perform telephonic member outreach and document telephonic interaction outcomes using appropriate note templates Follow standard operating procedures and utilize required scripting Deliver member outreach using a motivational interviewing style of communication Perform medication and disease state clinical discussions to improve health outcomes Use active and reflective l

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, at least restrictive level of care Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact

Apply clinical knowledge to Case Managers behavioral health reviews to enrollee's identified as needing or receiving behavioral health services Conduct behavioral health consults with Case Managers, daily and maintain a quarterly schedule for identified members needing or receiving behavioral health services Serve as member advocate by addressing stigma, following Guiding

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, at least restrictive level of care Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact

Test Data Provision & Masking Operation Test data need & masking analysis ( Data structure, SQL queries) Working with Informatica tool to configure & invoke Data Copy and Masking jobs and maintain Gold Copy Maintenance of TDM Portal using UNIX scripting, Java Spring boot and Angular You'll be rewarded and recognized for your performance in an environment that will challen

Answer incoming phone calls from customers and identify the type of assistance the customer needs (i.e. benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits (EOBs) Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems Own problem t

Assess, plan and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care Identify and initiate referrals for social service programs; including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Com

Create/Own Demand forecasts using statistical models and probabilities to achieve financial and service objectives for multiple lines of business (E&I Member, Government Operations, and Provider) and the business plans (120 414) and their corresponding FTE counts (3500 13,000) including oversight and direction provided to the vendor demand planners Collaborate with Operat