Remote Provider Relations Leader (Claims & Access)

UnitedHealth Group; Eden Prairie (MN); Remote; USD 73,000 - 130,000; Full time

Job summary

UnitedHealth Group in Minnesota seeks a Senior Provider Relations Advocate to manage complex provider escalations, research issues across claims, payment, and access, and liaise between providers, internal teams, payers, and leadership. The role emphasizes root-cause analysis and improving resolution outcomes while reducing operational friction.

The ideal candidate has a solid claims background, strong analytical and relationship-management skills, and the ability to work CST hours with flexible

Qualifications

• High school diploma or equivalent.
• 3+ years of experience in healthcare operations, provider relations, claims, network management, customer service, or related healthcare field.
• Experience researching and resolving complex provider issues.
• Facets claim system experience.
• Microsoft Office, including Excel experience with pivot tables.
• Demonstrated solid problem-solving, analytical, and critical thinking skills.
• Demonstrated excellent verbal and written communication skills.
• Demonstrated ability to manage multiple priorities in a fast-paced environment.
• Demonstrated ability to influence outcomes through collaboration and relationship building.

Responsibilities

• Manage end-to-end resolution of complex provider and operational escalations.
• Assess issue severity, business impact, urgency, and required actions.
• Investigate and resolve escalated issues involving claims and payment discrepancies, prior authorization concerns, provider/member data issues, eligibility concerns, provider incentive payment disputes, access and technology-related issues, and service-related concerns.
• Facilitate timely resolution through effective coordination across multiple business areas.
• Maintain ownership and accountability throughout the issue lifecycle from intake through closure.
• Research complex claims and payment inquiries using multiple systems and data sources.
• Analyze claim adjudication outcomes, payment methodologies, remittance information, and provider reimbursement concerns.
• Identify root causes impacting claims processing and payment accuracy.
• Partner with claims operations, payment integrity, health plans, network management, and other stakeholders to resolve issues.
• Educate providers and internal partners on claims processes, policies, and resolution pathways.
• Conduct detailed investigations into complex operational and provider issues.
• Analyze trends, recurring problems, and systemic barriers affecting provider satisfaction and operational performance.
• Identify opportunities for sustainable corrective actions.
• Develop recommendations that improve processes, workflows, and customer experience.
• Translate complex findings into actionable solutions for stakeholders and leadership.
• Serve as a trusted advocate for providers while balancing organizational policies and business objectives.
• Assess and interpret provider needs and requirements.
• Communicate complex information in a clear, professional, and customer-focused manner.
• Build and maintain positive relationships with providers and internal stakeholders.
• Partner with Operations, Network Management, Claims, Payment Integrity, Contracting, Client Services, Quality, Clinical Operations, Technology, and Payer organizations.
• Escalate systemic issues and risks to leadership as appropriate.

Skills

Problem solving

Analytical thinking

Communication skills

Relationship management

Time management

Team collaboration

Education

High school diploma or equivalent

Tools

Facets claim system

Microsoft Excel

Job description

UnitedHealth Group in Minnesota seeks a Senior Provider Relations Advocate to manage complex provider escalations, research issues across claims, payment, and access, and liaise between providers, internal teams, payers, and leadership. The role emphasizes root-cause analysis and improving resolution outcomes while reducing operational friction.

The ideal candidate has a solid claims background, strong analytical and relationship-management skills, and the ability to work CST hours with flexible