Senior Provider Relations Advocate - Remote

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

Benefits offered by this job

Remote work flexibility

Job summary

UnitedHealth Group, through OptumCare, is seeking a Senior Provider Relations Advocate for remote work across the United States. The role focuses on managing complex provider and operational escalations, researching root causes, and driving process improvements to enhance the provider experience.

The ideal candidate has a solid claims background, strong analytical and communication skills, and the ability to collaborate with cross-functional teams to resolve issues efficiently.

Qualifications

• 3+ years of experience in healthcare operations, provider relations, claims, or related field.
• Experience researching and resolving complex provider issues.
• Strong analytical and problem-solving skills.

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, payment, prior authorization, data, and eligibility.
• Coordinate across multiple business areas to facilitate timely resolution.
• Maintain ownership through intake to closure of issues.
• Research and root-cause analysis to identify trends and systemic barriers.
• Provide provider advocacy and build relationships with internal stakeholders.
• Collaborate with Operations, Network Management, Claims, Payment Integrity, and Payer organizations.

Skills

Claims analysis

Excel

Problem solving

Verbal & written communication

Education

High school diploma or equivalent

Tools

Facets system

Microsoft Office

Job description

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Senior Provider Relations Advocate - Remote (2388098)

Senior Provider Relations Advocate - Remote - 2388098

For those who want to invent the future of health care, here's your opportunity. We're going beyond basic care to health programs integrated across the entire continuum of care. Join us to start Caring. Connecting. Growing together.

The Senior Provider Relations Advocate serves as a subject matter expert responsible for managing complex provider, claims, payment, authorization, access, data, and operational escalations. This role acts as a liaison between providers, internal business partners, payer organizations, and leadership to ensure timely resolution of issues while improving the overall provider experience.

Working with minimal supervision, the Senior Provider Relations Advocate independently researches, analyzes, and resolves complex and often ambiguous issues that require cross-functional collaboration. This position plays a critical role in identifying root causes, driving accountability, escalating barriers, and recommending process improvements that reduce operational friction and improve resolution outcomes.

The ideal candidate possesses solid analytical, problem-solving, and relationship-management skills. A claims background is solidly preferred, as a significant portion of the role involves researching and resolving escalated claims, payment, and reimbursement issues.

The person hired into this role will need to be able to work Central Time Zone hours, generally 8am - 5pm, with some flexibility in schedule allowed.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary 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 and member data issues
  • Eligibility concerns
  • Provider incentive payment disputes
  • Access and technology-related issues
  • Operational 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
• Claims and Payment Resolution
  • Research complex claims and payment inquiries utilizing 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
• Research and Root Cause Analysis
  • 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
• Provider Advocacy and Relationship Management
  • 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
• Cross-functional Collaboration
  • 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

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 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

Preferred Qualifications:

• Experience with provider reimbursement, payment integrity, claims adjudication, or prior authorization workflows
• Experience managing escalated provider issues
• Experience conducting root cause analysis and implementing process improvements
• Experience working with cross-functional operational and technology teams
• Claims processing, claims operations, or claims resolution experience
• Knowledge of healthcare provider operations and managed care environments

Knowledge, Skills, and Abilities

• Advanced claims and payment analysis skills
• Knowledge of healthcare reimbursement methodologies and claims processes
• Solid investigation and research capabilities
• Root cause analysis and problem-resolution expertise
• Ability to work independently with minimal direction
• Solid organizational and prioritization skills
• Ability to effectively navigate ambiguous and complex situations
• Relationship management and conflict-resolution skills
• Proficiency with Microsoft Office applications and healthcare operational systems

All employees working remotely 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). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline:

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

OptumCare 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.

OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or accommodation for any part of the application process, please call 1-866-566-8715 to be connected to Recruitment Services. Recruitment Services hours of operation are 7 a.m. to 7 p.m. CT, Monday through Friday.

UnitedHealth Group is a registered service mark of UnitedHealth Group, Inc. The UnitedHealth Group name with the dimensional logo, as well as the dimensional logo alone, are both service marks for the UnitedHealth Group, Inc.

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-free workplace. Candidates are required to pass a drug test before beginning employment.