UnitedHealth Group is among the most ambitious Fortune 25 companies you'll ever meet. Through our family of businesses, we're working to make the health care system perform better for more people, in more ways than ever.
Simply put, we think the entire system can be greater than it's ever been. And that drives us to work harder, aim higher, and expect more from one another.
Here, you'll be empowered to make an immediate impact for millions of others. And you'll achieve more than you ever expected. How does that fit with your plans?
Stop Loss Clinical Analyst/medical underwriter-316511
UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.
Description UnitedHealthcare is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
When you work with UnitedHealthcare, what you do matters. It's that simple...and it's that challenging.
In providing consumer-oriented health benefit plans to millions of people, our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system.
Function Description
The Stop Loss Clinical Analyst position is responsible for supporting and working in tandem with all core operational business units within the confines of stop loss business processes. Assisting in the medical underwriting process by providing cost of care estimates related to new and renewal underwriting.
Serves as primary resource to claim auditors regarding medical necessity issues, standard of care, and fee analysis for reimbursement of submitted stop loss claims. Reviews any available claim notifications to establish future risk of potential stop loss reimbursements.
General Profile
Acts as subject matter expert in establishing and evaluating underwriting cost of care analysis based on diagnosis and paid claim data for new and renewal underwriting business.
Reviews jumbo claims for cost and medical necessity determinations where potential fraud or incorrect/unethical billing is questioned. These referrals may come from claim auditors and/or underwriting.
Reviews potential large claim notices and seeks out information needed to establish potential financial risk for current or future plan years.
Regardless of your role at UnitedHealthcare, the support you feel all around you will enable you to do what you do with energy, integrity, and confidence. So take the first step in what is sure to be a fast paced and highly diversified career.
Qualifications
- Works in Matrix environment, accountable to BP Inc. and UHC Underwriting and Pricing.
- Self-directed with strong time management and prioritization skills.
- Strong problem solving and decision making skills.
- Good written and verbal communication skills.
- Ability to be flexible, adjust quickly, and react positively to change.
- Strong team player.
- Will be trained and act as back up staff to National Accounts Medical Underwriter.
- Decisions are guided by policies, procedure, and business plan.
- RN or LPN license, current and unrestricted.
- Significant clinical experience, preferably within oncology, transplant medicine, or intensive care (five years).
- Five years experience in an insurance company, managed care environment, or third party administrator.
- Prior experience as a medical underwriter required.
- Computer Skills, including use of Microsoft Word and Excel required.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. |
