BlueCross BlueShield of Tennessee Jobs

BlueCross BlueShield of Tennessee (BCBST) is seeking four (4) skilled and compassionate Registered Nurses to join our fast-paced, high-performing team. These Medical Case Manager roles focus on supporting members with chronic health conditions, working alongside them and their providers to ensure timely, coordinated, and effective care. Our ideal candidates will be energized by engaging and connecting with members over the phone and through digital channels. They will find fulfillment in supporting our members through clear communication and proactive problem-solving. Whether it's guiding someone through a complex issue or simply offering a reassuring voice, our team members excel at making meaningful connections and delivering exceptional service with every interaction. To thrive on this fully remote team, you'll need to be tech savvy, adaptable, and experienced in managing complex patient needs. Experience supporting patients with chronic conditions such as Asthma, Coronary Artery Disease (CAD), Congestive Heart Failure (CHF), Chronic Obstructive Pulmonary Disease (COPD), and/or Diabetes is highly preferred. Job Responsibilities Supporting utilization management functions for more complex and non-routine cases as needed. Serving as a liaison between members, providers and internal/external customers in coordination of health care delivery and benefits programs. Overseeing highly complex cases identified through various mechanisms to ensure effective implementation of interventions, and to ensure efficient utilization of benefits Performing the essential activities of case management: assessment: planning, implementation, coordinating, monitoring, outcomes and evaluation. Digital positions must have the ability to effectively communicate via digital channels and offer technical support. Effective 7/22/13: This Position requires an 18 month commitment before posting for other internal positions. Various immunizations and/or associated medical tests may be required for this position. This job requires digital literacy assessment. Job Qualifications License Registered Nurse (RN) with active license in the state of Tennessee or hold a license in the state of their residence if the state is participating in the Nurse Licensure Compact Law. Experience 3 years - Clinical experience required 5 years - Experience in the health care industry For Select Community & Katie Beckett: 2 years experience in IDD for Select Community is required Skills\Certifications Currently has a Certified Case Manager (CCM) credential or must obtain certification within 2 years of hire. For Select Community & Katie Beckett: In addition to CCM, Certification in Developmental Disabilities Nursing (CDDN) is required at hire, or must be attained within 3 years. Excellent oral and written communication skills PC Skills required (Basic Microsoft Office and E-Mail) Employees who are required to operate either a BCBST-owned vehicle or a personal or rental vehicle for company business on a routine basis* will be automatically enrolled into the BCBST Driver Safety Program. The employee will also be required to adhere to the guidelines set forth through the program. This includes, maintaining a valid driver's license, auto insurance compliance with minimum liability requirements; as defined in the “Use of Non BCBST-Owned Vehicle” Policy (for employees driving personal or rental vehicles only); and maintaining an acceptable motor vehicle record (MVR). *The definition for "routine basis" is defined as daily, weekly or at regularly schedule times. Number of Openings Available: 1 Worker Type: Employee Company: BCBST BlueCross BlueShield of Tennessee, Inc. Applying for this job indicates your acknowledgement and understanding of the following statements: BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law. Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page: BCBST's EEO Policies/Notices BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means. Tobacco-Free Hiring Statement To further our mission of peace of mind through better health, effective 2017, BlueCross BlueShield of Tennessee and its subsidiaries no longer hire individuals who use tobacco or nicotine products (including but not limited to cigarettes, cigars, pipe tobacco, snuff, chewing tobacco, gum, patch, lozenges and electronic or smokeless cigarettes) in any form in Tennessee and where state law permits. A tobacco or nicotine free hiring practice is part of an effort to combat serious diseases, as well as to promote health and wellness for our employees and our community. All offers of employment will be contingent upon passing a background check which includes an illegal drug and tobacco/nicotine test. An individual whose post offer screening result is positive for illegal drugs or tobacco/nicotine and/or whose background check is verified to be unsatisfactory, will be disqualified from employment, the job offer will be withdrawn, and they may be disqualified from applying for employment for six (6) months from the date of the post offer screening results. Resources to help individuals discontinue the use of tobacco/nicotine products include smokefree.gov or 1-800-QUIT-NOW.

You could be the one who changes everything for our 28 million members as a clinical professional on our Medical Management/Health Services team. Centene is a diversified, national organization offering competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Assist the Chief Medical Director to direct and coordinate the medical management, quality improvement and credentialing functions for the business unit. Those able to work MST or PST hours, preferred Provides medical leadership of all for utilization management, cost containment, and medical quality improvement activities. Performs medical review activities pertaining to utilization review, quality assurance, and medical review of complex, controversial, or experimental medical services, ensuring timely and quality decision making. Supports effective implementation of performance improvement initiatives for capitated providers. Assists Chief Medical Director in planning and establishing goals and policies to improve quality and cost-effectiveness of care and service for members. Provides medical expertise in the operation of approved quality improvement and utilization management programs in accordance with regulatory, state, corporate, and accreditation requirements. Assists the Chief Medical Director in the functioning of the physician committees including committee structure, processes, and membership. Conduct regular rounds to assess and coordinate care for high-risk patients, collaborating with care management teams to optimize outcomes. Collaborates effectively with clinical teams, network providers, appeals team, medical and pharmacy consultants for reviewing complex cases and medical necessity appeals. Participates in provider network development and new market expansion as appropriate. Assists in the development and implementation of physician education with respect to clinical issues and policies. Identifies utilization review studies and evaluates adverse trends in utilization of medical services, unusual provider practice patterns, and adequacy of benefit/payment components. Identifies clinical quality improvement studies to assist in reducing unwarranted variation in clinical practice in order to improve the quality and cost of care. Interfaces with physicians and other providers in order to facilitate implementation of recommendations to providers that would improve utilization and health care quality. Reviews claims involving complex, controversial, or unusual or new services in order to determine medical necessity and appropriate payment. Develops alliances with the provider community through the development and implementation of the medical management programs. As needed, may represent the business unit before various publics both locally and nationally on medical philosophy, policies, and related issues. Represents the business unit at appropriate state committees and other ad hoc committees. Education/Experience: Medical Doctor or Doctor of Osteopathy. Utilization Management experience and knowledge of quality accreditation standards preferred. Actively practices medicine. Course work in the areas of Health Administration, Health Financing, Insurance, and/or Personnel Management is advantageous. Experience treating or managing care for a culturally diverse population preferred. License/Certifications: Board certification in a medical specialty recognized by the American Board of Medical Specialists or the American Osteopathic Association's Department of Certifying Board Services. Current state license as a MD or DO without restrictions, limitations, or sanctions from government programs. Pay Range: $231,900.00 - $440,500.00 per year Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law. Total compensation may also include additional forms of incentives. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. The CA Provider Data Maintenance (PDM) Manager will lead, support, and develop a growing team responsible for loading and maintaining provider demographic and network data across multiple systems. . This role is to lead is a newly established team in our organization and offers an exciting opportunity for a motivated, analytical, and results-driven leader. We are seeking a compassionate and supportive people-first leader who prioritizes team development, employee engagement, and fostering a positive, inclusive work environment. The ideal candidate will proactively learn about acquired platforms and processes, build effective reporting methods, set team goals collaboratively, and drive continuous improvement with empathy and transparency. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: * Cultivate a supportive, inclusive team culture that encourages open communication, trust, collaboration, and professional growth * Lead, mentor, and coach direct reports, ensuring their needs are understood, goals are clear, and resources are provided for their success * Build effective resource-balancing plans to ensure appropriate staffing, cross-training, and workload management across multiple provider data platforms * Set clear, measurable team and individual performance objectives, monitoring metrics including quality, on-hand and completion volumes, turnaround times, productivity, efficiency, utilization, and shrinkage * Provide regular, meaningful feedback and coaching to team members, helping them reach performance and developmental goals * Manage workload inventory effectively, ensuring prioritization aligns with business needs and service-level agreements * Partner to develop accurate reporting methods and performance dashboards to track and communicate team outcomes, successes, and improvement opportunities * Proactively communicate team performance, highlights, challenges, and proposed solutions clearly and effectively to various stakeholders, including senior leadership * Collaborate with cross-functional teams to identify opportunities for operational improvement, streamline workflows, and enhance data quality and accuracy * Actively participate in goal-setting processes, demonstrating flexibility and responsiveness to evolving business needs Competencies for Success: * Highly organized, detail-oriented, and capable of managing multiple priorities within a dynamic operational environment * Solid analytical, critical thinking, and problem-solving skills to quickly understand and improve new and evolving processes * People-First Leadership: Consistently demonstrates empathy, compassion, and genuine care for the well-being and professional development of employees * Collaborative Approach: Creates an environment of trust, respect, and open communication, encouraging team members to share ideas and solutions openly * Effective Communication: Clearly conveys performance expectations, feedback, and operational updates across all levels of the organization * Adaptability & Flexibility: Quickly learns new systems and processes, comfortably adapting to evolving priorities and business * Excellent interpersonal and communication skills, with the proven ability to build trust and positively influence others 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: * 2+ years of demonstrated experience managing and developing teams, with a solid emphasis on employee growth, engagement, and well-being * 2+ years of experience successfully managing operational performance metrics and goals in a production-driven environment * 1+ years of experience presenting materials to senior leader and/or large audiences * Proficient with Microsoft Office tools (Excel, Word, PowerPoint, Outlook) and comfortable using data to drive decisions Preferred Qualifications: * 1+ years of experience managing provider demographic data, healthcare data platforms (such as FACETS, IDX, etc), claims, billing, or healthcare provider operations * Experience in a growing or rapidly changing operational team, demonstrating adaptability, resilience, and effective change management skills * Familiarity with healthcare regulatory standards, provider credentialing, contracting, and reimbursement methodologies * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy The salary range for this role is $71,600 to $140,600 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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. 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. UnitedHealth Group 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. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

**Resp & Qualifications** **PURPOSE:** Leads multiple cross functional teams, or Agile Release train (ART) guiding them on how to use Agile, Scaled Agile Framework (SAFe), Scrum and Lean (e.g. Kanban) values/practices through servant leadership in the Data & Analytics Organization. Creates and nurtures a culture of continuous learning, growth mindset and agile maturity in teams/ART through agile practices, agile mindset, metrics, SAFe guidelines, removes blockers and partners with leadership. Exhibits and permeates the behaviors of a Lean-Agile Leader with a Lean-Agile Mindset. **ESSENTIAL FUNCTIONS:** + Facilitates the teams progress toward team goals.The Senior Scrum Master acts as the facilitator for many teams or as the Release Train Engineer (RTE) for a SAFe Agile release train (ART). Continuously engage in challenging the old ways of working to improve team level or ART level performance in the areas of quality, predictability, flow, velocity and other metrics defined by the enterprise.Helps the team improve and take responsibility for their actions; facilitates the team retrospective.Teaches problem-solving techniques and helps the team become better problem-solvers for themselves.Organizes and facilitates all Scrum ceremonies, including Spring Planning, Daily Stand-Ups, Spring Reviews, and Sprint Retrospectives.Ensure they are productive, efficient and focused on delivering value. + Supports the team's efforts to continuously improve communications and relationships with other teams. Takes a lead role in coordinating work with other teams to improve flow and throughput. Frequently represent the team in the Scrum of Scrums (SoS), or run the Scrum of Scrum meeting, and/or other program level ceremonies to plan, execute, and improve the work & operating models. Helps their teams remain aware of opportunities to engage and improve larger program effectiveness. Helps their teams build effective relationships with the supporting teams like User Experience, Architecture, Shared Services etc. Supports the Product Owner and Product Management areas in their efforts to manage the backlog and guide the team while facilitating a healthy team dynamic with respect to priorities and scope. + Eliminates impediments by engaging the right stakeholders within the organization or partner organizations. The Senior Scrum Master supports the team/ART in addressing and eliminating these issues to improve the likelihood of achieving the objectives of the Iteration or PI. Assists with internal and external communication and improves transparency. + Exhibits and infuses the behaviors of a Lean-Agile Leader to nurture a Lean-Agile Mindset in the team, leadership and the program. Provide input and lead initiatives to improve business agility in the team/program/enterprise. Identify and drive the culture change required to improve agility within their teams and ART's. **SUPERVISORY RESPONSIBILITY:** Leads a team utilizing a matrix management system. **QUALIFICATIONS:** **Education Level:** Bachelor's Degree in Business Administration or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. **Licenses/Certifications:** + SAFe Scrum Master Certification Upon Hire Preferred + Certified Scrum Master (CSP) Upon Hire Required + Certified SAFe? Release Train Engineer Preferred + Certified Scrum Professional Preferred **Experience:** 8 years or equivalent in the use of Lean, Agile methodologies including three plus years as Scrum Master or Kanban lead. Proven success leading multiple Agile teams to agile maturity and improved customer outcomes. **Preferred Qualifications:** + Scrum Master on a SAFe Agile Release train. + Leading Change and continuous improvement, working with a cross functional team by applying lean agile methods. + Experience doing value stream mapping, system level optimizations etc. applying Theory of Constraints and other Lean techniques. **Knowledge, Skills and Abilities (KSAs)** + Knowledge of Lean Agile values, principles and practices. + Knowledge of Lean agile frameworks like Scrum, Kanban. + Knowledge of Scaling frameworks like SAFe. + Demonstrate strong and clear accountability for program success. + Knowledge of Product Ownership, DevOps, Test Automation practices etc. + Excellent communication skills written and oral. + Self-starter with ability to prioritize work while meeting multiple deadlines. + Ability to organize data and create metrics/reports/dashboards. + Proficient in Microsoft Office programs and industry standard Agile tools. + Ability to drive change at different levels, manage conflicts constructively. + Must be able to meet established deadlines and handle multiple customer service demands from internal and external customers, within set expectations for service excellence. Must be able to effectively communicate and provide positive customer service to every internal and external customer, including customers who may be demanding or otherwise challenging. **Salary Range:** $104,976 - $208,494 **Salary Range Disclaimer** The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Data Architecture **Equal Employment Opportunity** CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. **Where To Apply** Please visit our website to apply: ************************* **Federal Disc/Physical Demand** Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. **PHYSICAL DEMANDS:** The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. **Sponsorship in US** Must be eligible to work in the U.S. without Sponsorship \#LI-HS1 REQNUMBER: 20554

You could be the one who changes everything for our 28 million members. Centene is transforming the health of our communities, one person at a time. As a diversified, national organization, you'll have access to competitive benefits including a fresh perspective on workplace flexibility. Position Purpose: Analyze, develop, implement and monitor clinical quality improvement initiatives to achieve healthy outcomes. Perform duties and functions to comply with quality improvement programs according to state requirements. Support Quality Assurance Performance Improvement work plan/initiatives. Schedule and assist with committee and sub-committee preparation. Assist in investigation and resolution of member quality of care complaints. Audit medical records and monitor performance measures for health care risk management, sentinel events and trends. Education/Experience: Bachelor's degree in nursing preferred. 2+ years clinical, quality management or healthcare related experience. At least one year experience in quality function in a healthcare setting. License/Certification: LPN, LVN, RN, PA, or LCSW license preferred. Utilization management certification preferred. Certified Professional in Healthcare Quality preferred.Pay Range: $26.50 - $47.59 per hour Centene offers a comprehensive benefits package including: competitive pay, health insurance, 401K and stock purchase plans, tuition reimbursement, paid time off plus holidays, and a flexible approach to work with remote, hybrid, field or office work schedules. Actual pay will be adjusted based on an individual's skills, experience, education, and other job-related factors permitted by law, including full-time or part-time status. Total compensation may also include additional forms of incentives. Benefits may be subject to program eligibility. Centene is an equal opportunity employer that is committed to diversity, and values the ways in which we are different. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, veteran status, or other characteristic protected by applicable law. Qualified applicants with arrest or conviction records will be considered in accordance with the LA County Ordinance and the California Fair Chance Act

Be Here. Be Great. Working for a leader in the insurance industry means opportunity for you. Great American Insurance Group's member companies are subsidiaries of American Financial Group. We combine a "small company" culture where your ideas will be heard with "big company" expertise to help you succeed. With over 30 specialty and property and casualty operations, there are always opportunities here to learn and grow. At Great American, we value diversity and recognize the benefits gained when people from different cultures, backgrounds and experiences work collaboratively to achieve business results. We are intentionally focused on fostering an inclusive culture and know valuing diversity is an essential leadership quality. Our goal is to create a workplace where all employees feel included, empowered and enabled to perform at their best. Great American's Professional Liability Division offers both medical and non-medical service providers protection from claims alleging an act, error, or omission by the firm, its staff, or contractors working on its behalf. The Division recognizes that every industry has unique needs and develops customized coverage solutions for specific professional liability exposures. Their products include: Medical Professional & Telehealth Liability Accountants Professional Liability Design Professionals Liability Miscellaneous Professional Liability Real Estate Professional Liability Lawyers Professional Liability ******************************************************************************************************** The Medical Professional & Telehealth Liability team is looking for an Underwriter to join its dynamic team. This position is fully remote and offers a unique opportunity to work on a blend of telehealth and miscellaneous medical (misc. med) professional liability risks. The successful candidate will be responsible for underwriting both small and complex risks, working closely with the hiring manager in a startup-like environment within a stable, established organization. Essential Job Functions and Responsibilities Manage a diverse portfolio of miscellaneous medical and telehealth accounts, handling risk selection, pricing, retention, growth, and profitability. Balance high-volume, quick-turnaround accounts with more complex telehealth and tech-related accounts that require thoughtful, detail-oriented underwriting. Analyze submissions, determine terms, and price business according to guidelines. Assess risk quality and compliance, making recommendations on risks beyond authority. Monitor premiums, costs, and claims ratios, taking corrective measures to ensure profitability. Collaborate closely with the hiring manager to shape the product and contribute to the growth of this new product. Actively contribute ideas and feedback to improve underwriting processes, coverage options, and product development. Maintain high standards of customer service, fostering strong business relationships with brokers and stakeholders. Participate in occasional travel for team events, conferences, and broker meetings. Perform other assigned duties. Job Requirements Bachelor's degree in Risk Management, Finance, Accounting, or a related discipline. Generally, 3-7 years of related miscellaneous medical professional liability or healthcare underwriting experience. Experience balancing both high volume of small business accounts and more complex risks. In the process of obtaining, or already have, certifications such as CPCU, RPLU, AINS, or similar designations. Self-motivated and independent, with strong relationship management skills and the ability to thrive in a remote work environment. Collaborative and open-minded, able to contribute ideas and help shape a growing team. Ability to travel up to 20% of the time to visit agents and brokers. Business Unit: Professional Liability Salary Range: $100,000.00 -$115,000.00 Benefits: Compensation varies by role, position level, and location. Individual pay is influenced by skills, education, training, certifications, experience, and the role's scope and complexity, along with business needs. We offer a competitive Total Rewards package, including medical, dental, and vision plans starting on day one, PTO, paid holidays, commuter benefits, an employee stock purchase plan, education reimbursement, paid parental leave/adoption assistance, and a 401(k) plan with company match. These benefits are available to eligible full-time and part-time employees. Your recruiter can provide more details about our total rewards and specific compensation ranges during the hiring process.

Physician Pathways: Prepare for Day One at your practice up to one year in advance of completing your resident of fellowship program. As a Pathways Physician, you'll receive a salary, mentoring, and various other learning experiences focused on preparing for your career with the Optum American Health Network with minimal impact on your Resident training time. Interested in learning more about Value Based Care before day one? Getting to know your peers? Ease the stress of your transition to physician provider with an unparalleled head start "virtually" Optum American Health Network Primary Care Physicians -- Ohio Pathways 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. As a part of the Optum network, American Health Network is seeking career-minded Family Medicine or Internal Medicine residents who want to jump start their clinical career. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Position Highlights: * Receive a generous guaranteed salary in your final year of training * Enhance the experience of your final months of training and eliminate the burden of job searching; employment is guaranteed at the completion of your residency * Learn how to practice and thrive in a value-based care model * Gain exposure to the Quadruple Aim framework and various understandings of care settings * Receive mentorship from experienced physicians within your future practice, easing your transition from training into practice * The customized program will be completed at American Health Network facilities in Indiana, or Ohio, and virtually * The program requires a commitment of only a few hours per month What makes Optum different? * Providers are supported to practice at the peak for their license * As one of the most dynamic and progressive health care organizations in the country, Optum consistently delivers clinical outcomes that meet or exceed national standards * We promote a culture of clinical innovation and transformation * We are a top performer nationally of the Quadruple Aim initiative * We are influencing change on a national scale while still maintaining the culture and community or our local organizations 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. Key Takeaways: * Optum fosters a collaborative culture focused on growth, innovation and mutually uplifting one another, enabling deep physician satisfaction * Tailored development programs like Physician Pathways smooth the transition from training to practice with expert mentorship * Physicians praise the supportive environment facilitating work-life balance, strong patient connections, and the ability to push care delivery boundaries Required Qualifications: * M.D. or D.O. * Must be transitioning into your final year of residency or fellowship Preferred Qualification: * Preferred candidate will be a local physician resident in Ohio--open to other areas as well Would you thrive with Optum? * Do you strive to practice evidence-based medicine? * Are you seeking a practice focused on patient-centered quality care, not volume? * Are you a team player - comfortable delegating and empowering teams? * Are you constantly seeking better ways to do things? * Do you want to be part of something better? About Optum: At Optum, we've found that putting clinicians at the center of care is the best way to improve lives. Our physician-led organization is one of the most dynamic and progressive health care organizations in the world, serving almost 130 million people through more than 78,000 aligned physicians and advanced practice clinicians. You will find our team working in local clinics, surgery centers and urgent care centers, within care models focused on managing risk, higher quality outcomes and driving change through collaboration and innovation. Learn more at ************************************ * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy 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. Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment

**Resp & Qualifications** **PURPOSE:** Provides support in areas of Executive and Board Support, organizational, Annual Plan (Plan) and Budget Management, Culture and Communications, and Project and Program Coordination. The position operates as a direct extension of the divisional Executive Vice President and is responsible for managing the day-to-day operations, strategy and planning of the department including maintaining division priorities, internal and external communication, reporting and analysis relating to the division, budget management, cross-company collaborations as well as special projects at the request of the Executive leader. **ESSENTIAL FUNCTIONS:** + Research and conduct necessary analysis in response to requests of the leadership team, and present results as required. Engage in proactive problem solving including: problem identification, definition, analysis and recommendation as an individual producer and as a catalyst in small group settings. Deliverables include verbal reports and detailed reports designed to monitor and encourage delivery against milestones contained in the divisions operational and strategic plan, including monitoring and analysis of key performance indicators. + Conduct process analysis within division, document, make recommendations and implement improvements. Coordinate with key internal partners to ensure solid communication and workload preparation. + Create department communications, policies and procedures for both internal and external usage, coordinate internal reporting requirements for the division, including division dashboards, create presentations for upper management, and educate teams and management on issues, policies and procedures where appropriate. Prepare for executive and Board meetings that draw together key documents and oral history; synthesize and compress key issues and recommendations; suggest prior communications as necessary to clarify views or obtain required additional information and provide short verbal brief to the Executive Vice President. + Coordinate the development and analytical review of the administrative expense budget, monthly expense analysis and expense forecasting as well as acquisition (the purchasing and oversight of outside and intra-company services and/or products), personnel and other operating performance data to track performance against plan. + Builds and maintains a solid professional relationship with members of the division and is proficient and knowledgeable about the divisions strategy and goals that support the strategic direction of the company. Serve as point of contact and coordinator for corporate and divisional consulting engagements. **QUALIFICATIONS:** **Education Level:** Bachelor's Degree in Business Administration or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. **Experience:** 2 years experience in business, healthcare environment, health insurance payor environment. 2 years related project management experience in a large scale, cross functional, multi-system environment. **Preferred Qualifications** : + 6 years experience in business, healthcare/health insurance environment, or related field. + Ability to train and mentor others. + Ability to recognize, analyze, and solve a variety of problems. **Knowledge, Skills and Abilities (KSAs)** + Ability to work as a team member. + Proficient in Microsoft Office applications. + Proficient in project planning and life cycle development. + Excellent communication skills both written and verbal. Salary Range: $94,320 - $187,330 **Salary Range Disclaimer** The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Chief Digital Information Offi **Equal Employment Opportunity** CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. **Where To Apply** Please visit our website to apply: ************************* **Federal Disc/Physical Demand** Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. **PHYSICAL DEMANDS:** The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. **Sponsorship in US** Must be eligible to work in the U.S. without Sponsorship. \#LI-SD1 REQNUMBER: 21043

**Resp & Qualifications** **PURPOSE:** This position oversees and directs the work of analysts in a supervisory capacity. This position is responsible for implementing departmental strategy and policies in order to meet team goals, as well as making recommendations to Actuarial management where appropriate. **ESSENTIAL FUNCTIONS:** + Responsible for coordinating the activities analysts ensuring accurate and timely release of requested analyses and reports. Responsible for providing training, development, documenting performance issues, if needed, and monitoring and enforcing adherence to Company policies. The Supervisor sets objectives, writes and deliveries performance feedback and appraisals, promotions, salary increases, hiring and disciplinary communications. + Responsible for coordinating the development and extensive analytical review of various actuarial analyses such as IBNR, trend, rating actions, and valuation work in support of departmental objectives. This includes supporting the junior team members, working with other areas within the Company, producing presentations for senior management and communicating status of deliverables to the department management. + Oversee calculations, serve as Subject Matter Expert (SME), direct the workflow and ensure that sound actuarial and financial methods are used by Analysts. **SUPERVISORY RESPONSIBILITY:** This position manages people. **QUALIFICATIONS:** **Education Level:** Bachelor's Degree in Actuarial Science, Finance, Mathematics or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. **Licenses/Certifications:** Associate of the Society of Actuaries (ASA) Required. **Experience:** 3 years health actuarial experience with demonstrated leadership. **Knowledge, Skills and Abilities (KSAs)** + Ability to organize to task completion, plan and prioritize work. + Must demonstrate flexibility, innovation and problem-solving skills and resourcefulness. + Ability to express technical and financial analysis in a clear, concise manner on both written and oral form. + Must possess negotiating and consulting skills. + Possesses highly developed analytical skills and excellent interpersonal and communication skills, both written and oral. + Effectively convey actuarial and/or underwriting issues to a diverse audience. **Salary Range:** $97,344 - $200,772 **Salary Range Disclaimer** The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** PBM **Equal Employment Opportunity** CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. **Where To Apply** Please visit our website to apply: ************************* **Federal Disc/Physical Demand** Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. **PHYSICAL DEMANDS:** The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. **Sponsorship in US** Must be eligible to work in the U.S. without Sponsorship. \#LI-CB1 REQNUMBER: 19857

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. Individual and Family Plans (IFP) is a growing business within UnitedHealthcare. The Coding Consultant for IFP Product provides medical coding expertise to support internal policy development, benefit definition and accurate benefit configuration. They research and interpret healthcare correct coding using regulatory requirements and guidance related to CMS and CPT/AMA, review other major payer policies, and use internal business rules and policies to prepare written documentation in support of benefit configuration. The Coding Consultant for IFP Product possesses an overall understanding of all coding principles, including facility and physician coding and dental coding. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: * Serve as a coding resource and provide coding expertise and guidance for IFP Product and configuration partners * Develop and maintain code sets used to define IFP medical and specialty benefits (hearing, vision, dental), seeking and promoting enterprise alignment when appropriate * In partnership with Product and Clinical partners, ensure IFP sources of truth for benefit administration/configuration (e.g., benefit configuration guidelines, Pay Code Status lists, etc.) contain accurate and complete CPT, HCPCS, Revenue, CDT and/or ICD-10 codes to support benefit intent * Monitor annual and quarterly code updates, identify impacts to IFP Product documentation, and update documentation as needed * Ensure adherence to state and federal policies/mandates, reimbursement policies and contract requirements * Facilitate meetings with key partners, including: Clinical, Operations, Claims, Configuration and others to achieve benefit design coding solutions * Research and interpret correct coding guidelines and internal business rules to respond to benefit inquiries and issues * Identify and recommend opportunities for cost savings and improving outcomes 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: * 3+ years of medical coding experience in a health insurance product implementation, benefit/coverage policy development, benefit configuration, or claims role * Have and maintain one or more of the following coding credentials: CPC, CCS-P, CCS, CPMA or equivalent * Experience analyzing data and/or regulatory requirements, problem solving, and providing fact-based recommendations or make decisions based on analysis * Experience performing clinical coverage review of post-service (pre-or-post payment) of claims requiring interpretation of state and federal mandates; certificates of coverage, medical and reimbursement policies, coding requirements and consideration of relevant clinical information on claims * Experience multi-tasking, prioritizing, and managing time efficiently across multiple work partners * Knowledge of Commercial medical insurance benefits Preferred Qualifications: * Experience with health insurance reimbursement policy * Familiarity of SNOMED, LOINC, NDC and CDT * Experience in the plan build/plan configuration * Proficient in Microsoft Word, Excel, PowerPoint, etc. * Demonstrated ability to work collaboratively and influence others to drive timely decisions * Ability to work independently, or as an active member of a team * Accurate and precise attention to detail * Excellent analytical, verbal and written communication skills * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy The salary range for this role is $89,800 to $176,700 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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. 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. UnitedHealth Group 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. UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.** Manage multiple research projects to achieve the stated goals of the client and Optum Life Sciences. The Retrospective Research Project Manager is responsible for planning, organizing and managing all aspects of assigned clinical and non-clinical research activities on behalf of Optum Life Sciences Health Outcomes and Economics Research. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Lead operational aspects of research projects on behalf of Optum Life Sciences + Coordinate the efforts of all project team members and vendors to execute all project activities according to project milestones and timelines in a manner consistent with Optum Life Sciences and project-specific processes + Ensure project implementation per the study contract, client expectations, and Optum Life Sciences standard operating procedures (SOP) + Identify necessary study and regulatory approvals (e.g. Institutional Review Board, compliance, privacy, health plan) and lead submission processes + Lead contracting with clinicians, vendors, and consultants + Act as primary contact for internal team members, key functional departments, and vendors for project questions. Function as liaison between external clients and Optum as directed. Serve as back up or stand-in for next level of management when required + Develop, implement, and maintain electronic study tracking system for the project + Proactively anticipate and recognize, client needs + Anticipate, recognize, and resolve issues. Recognize the need to seek assistance or inform senior management of specific issues + Manage changes in project scope and work with Business Development and study team on contract amendments + Track, report, and manage invoicing and revenue for assigned projects. Work with the financial department to resolve issues + Perform budget and revenue forecasting to ensure project goals are achieved according to client and Optum Life Sciences expectations + Review, track, and manage study documents for completeness and accuracy + Maintain and store electronic study files in accordance with standard departmental processes + Develop, maintain, and communicate project timelines and status reports with external clients, internal project team members, key functional departments, vendors, and external consultants + Schedule, attend, and take notes for client and internal team meetings. Assist project director with meeting materials and meeting follow-up as needed + Contribute to the development of standard operating procedures, training, and infrastructure activities for HEOR Optum + Function appropriately and effectively within the matrix management system to assure project priorities and functional line considerations are aligned + Manage personal career development 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:** + 2+ years of relevant project management experience + Demonstrated experience in project management tasks (e.g., work plans, financial budgets, timelines, status reports, issue management, resource and personnel management) + Experience working on a team across multiple functional areas (e.g., work with Quality Assurance, Data Management, Legal, Institutional Review Boards, Privacy Boards, Finance) + Demonstrated ability to support project teams + Demonstrated success in meeting project time, quality, and financial targets in matrix organizations + Proven excellent communication, relationship building, and interpersonal skills + Proven excellent organizational skills and ability to prioritize and multitask + Proficient in Microsoft Office (e.g., Word, Excel, Access, and Outlook + Established ability to work both independently and as part of a cross-functional team **Preferred Qualifications:** + Experience in clinical or non-clinical research + Proven knowledge of research design and methodology. Knowledge of Human Subjects Protection and HIPAA + Experience with MS Project + Ability to provide clients and internal team members with complete and accurate information. Quickly identifies needs and follows through on commitments made. Maintains a high energy level when interacting with customers. Demonstrates professionalism and presents a positive image of the company + Demonstrated ability to make sound decisions. Focuses on resolving problems and makes decisions in a timely manner. Promptly notifies project team of the problem and any decisions made *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 $71,200 to $127,200 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._ _UnitedHealth Group 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._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start **Caring. Connecting. Growing together.** The Optum Client Executive (CE) is responsible for serving as the key strategic point of contact for a portfolio of 3-7 of the enterprise's top employer clients. The CE will serve as a client's bridge across the Optum enterprise and is charged with establishing deeply embedded relationships with the clients' C-suite to earn trusted advisor status with clients. The CE will work directly with Optum and UHG C-suite level sponsors as well as business-level account owners to harness the power of the enterprise and execute strategic problem solving and innovative solutioning for clients. Through their enterprise-wide lens, the CE will drive one Optum positioning within their client portfolio and will collaborate with Optum Health, Optum Rx and Optum Insight businesses to align on customer plans and priorities. Success for this role will be represented by stellar client retention, expansion, NPS and issue resolution. The client executive will have solid critical thinking skills, demonstrated success in driving complex growth and account plan strategies, outstanding cross-group organizational skills and agility, and highly effective communication skills (verbal and written). You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + **Serving as a client advocate, assuming ownership for the client relationship and being the driving force of change while facilitating cross Optum collaboration** + **Builds relationships with client decision makers and influencers, understanding their needs and providing Optum solutions** + **Collaborates with business-level account owners to ensure seamless and cohesive end-to-end enterprise representation** + **Leverages UHG assets to curate and architect meaningful in-person activities that drive value and increase credibility** + **Recognized as a trusted voice of authority regarding strategic thought-leadership on the client's industry and the employer market** + **Develops and monitors client financial performance and profitability** + Identifies whitespace opportunities, works with business partners and the client to co-create broader and more valuable solutions (for the client as well as Optum) for discussion and development + Demonstrates the value of Optum solutions and performance metrics to ensure clients are deriving the desired benefits from purchased Optum solutions + Collaborates with business partners, and direct resources across Optum, to evolve to meet client needs in bold new ways, enabling Optum to remain as the industry leader in shaping the health care ecosystem + Partners with client delivery teams to ensure client expectations of service and execution are clearly understood, communicated and met + Creates and maintains Enterprise Client Plans for assigned clients. Works with the business unit leaders to execute, update and refresh the plan throughout the year + Develops a deep understanding of client organizational dynamics, business challenges, and purchasing patterns + Achieves client satisfaction and NPS goals, facilitates issue resolution and flawless service delivery 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:** + 10+ years of progressive experience and leadership roles in the Health Care industries with a proven record of leading growth programs and delivering measurable results + 5+ years in managed services, including delivery and operation + Demonstrated experience in driving deep, productive relationships with C-Suite and Board of Directors + Demonstrated experience selling to Fortune 100 employers + Demonstrated track record of success driving client success across highly complex and matrixed organizations + Demonstrated history of leading, influencing and managing indirect, matrixed teams with successful people and team leadership experience - motivating, mentoring, and developing talent + **Proven advanced consultative selling skills with ability to successfully construct solutions for a wide variety of unique client/market problems** + **Proven e** xcellent negotiation, influencing, collaboration and listening skills + Demonstrated track record of active collaboration, engagement, oversight and strategy development of key growth opportunities + Demonstrated excellent oral and written communication skills and ability to build credibility and gain the respect and confidence of clients and internal partners + Willing and able to travel 50% of the time on a sustained basis *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy The salary range for this role is $130,000 to $240,000 annually based on full-time employment. Role is also eligible to receive bonuses based on sales performance. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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. **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._ _UnitedHealth Group 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._ _UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. Individuals in this position will have the primary accountability for the effective execution of delivering operational performance across all Payment Integrity value streams and to drive cost improvements and overall efficiencies for the organization. The Sr. Business Performance & Analysis Consultant will be accountable for driving alignment with multiple internal business partners (finance, work force management, operations, BAR, and others) to ensure consistent accuracy in forecasting performance across numerous governing metrics. Additionally, this position will conduct and manage outcomes of various efforts that include reviewing, analyzing, trending, and presenting information for operational and business planning. To accomplish this task, this individual will partner with multiple value stream leaders to influence and drive business strategy while delivering several executive report-outs to senior leaders of Payment Integrity. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: * Partnering with senior leaders to influence, develop, and drive business strategy aligned to cost reduction and efficiency improvement * Support short and long term operational/strategic business activities - by developing, enhancing and maintaining operational information and models through research and analysis of data * Driving ideation and partnership amongst operational areas to ensure consistency and collaboration * Establish and maintain operational metric oversight and performance review in relation to production and utilization goals through analysis and trending of data. Then presenting information for operational and business planning review and consideration * Operational oversight of quarterly FTE and savings submissions, in partnership with finance, WFM, and BAR * Operational SME representative in all WFM related efforts (weekly/monthly meetings, backlog recovery plans, ad-hoc reporting and analysis requests, etc.). Identify and fix gaps in current process while ideating to evolve the current process for greater future success * Ensure timely delivery of In Flight Projects - Thereby ensuring yearly targets are met and captured in financial submissions and capacity planning * Manage globalization efforts from an onshore perspective for Payment Integrity * Oversee WAVE alignment between operations and WFM for both onshore and offshore teams * Serve as a catalyst for change - challenge the status quo and bring high level of intellectual curiosity to bear to innovate and improve operations 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: * 3+ years of workforce management experience * 3+ years of SG&A management experience * 3+ years of experience working in a global matrixed environment Preferred Qualifications: * Experience working with or leading various Payment Integrity functions * Experience in healthcare desired, but also interested in candidates from manufacturing, property & casualty, and banking businesses * Proven solid interpersonal skills, ability to work with all levels of management across all functional areas * Proven ability to produce superior results in a financial performance-oriented environment * Proven solid leadership and strategic planning skills within a matrix environment * Proven excellent communication, presentation and negotiation skills * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy The salary range for this role is $106,800 to $194,200 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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. 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. UnitedHealth Group 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. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start **Caring. Connecting. Growing together.** Oversees the Golden Outlook sales team and their markets to guide recruiting, training, and supervising of independent agents/agencies primarily focused on the Medicare Advantage market. This leadership position provides strategic direction and decisions in order to achieve assigned sales/membership growth targets nationally covering all regions, states, carriers, providers and products. **Primary Responsibilities:** + Manage the Golden Outlook sales team and national sales footprint + Manage Marketing and Engagement leaders + Develop sales/membership growth targets in collaboration with senior leaders and corporate objectives + Provide strategic direction and decisions for the Golden Outlook sales team to recruit, build and nurture independent agent/agency relationships - manage critical agency relationships + Provide strategic knowledge and direction to leadership regarding key carrier and provider relationships - manage key carrier and provider relationships + Manage budgets and resources to achieve sales/membership growth targets and financial targets (revenue and IOI) + Provide vision and direct execution of sales, marketing and engagement activities + Provide vision for a structured on-boarding process, leveraging corporate contracting, certification and training processes, tools, and systems + Work closely with Agent Onboarding, Contracting, and Commissions teams to ensure the Agency and Agent partners are served appropriately + Provide vision for formal and on-the-job training to ensure an accurate understanding of offered products, compliance/policy requirements, sales processes, brand and value proposition messages and sales systems + Ensure the Golden Outlook sales team appropriately builds and advances our brand and value proposition and represents our product portfolio and service offerings + Organize the Golden Outlook sales team activities to ensure effective and efficient coordination across the country + Act as a liaison between the Golden Outlook sales team and executive leaders to ensure agents/agencies are appropriately set up and supported across their lifecycle. This includes, contracting, licensing/appointment, certification, training, enrollment administration, commission payment, + agent servicing and compliance + Coach and manage the Golden Outlook sales team using data and insights to achieve quantitative and qualitative performance targets + Conduct regular meetings between the sales team and our agency, carrier, provider partners to review sales results/activities and provide direction on opportunities for improvement + Develop relationships to enhance overall national marketing and leverage best practices + Work with the carrier relations team to develop strategies to engage and contract with the appropriate carrier partners 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:** + Life and Health license + 15+ years of Medicare and/or Healthcare sales experience + 10+ years of management experience + 10+ years of business development skills + Proven excellent communication skills both verbal and written + Proven excellent relationship building skills to communicate value propositions + Ability to effectively manage business plans, timelines and people + Demonstrated solid relationships with national brokers/consultants and community organizations + Demonstrated solid relationships with national carriers and providers + Demonstrated MS Office and CRM tool (preferably SalesForce) proficiency + Access to reliable transportation and valid driver's license + Ability to travel nationally 75% of year The salary range for this role is $130,000 to $240,000 annually based on full-time employment. Role is also eligible to receive bonuses based on sales performance. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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. _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._ _UnitedHealth Group 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._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together. OptumRx is an innovative pharmacy benefit management organization managing the prescription drug benefits of commercial, Medicare, and other governmental health plans, as well as those of employers and unions. Services offered by the company include pharmacy network contracting, rebate contracting and administration, mail order pharmacy facilities, specialty drugs, and retail drug claims processing. OptumRx is part of Optum, a leading information and technology-enabled health services business dedicated to making the health system work better for everyone. The Director External Audit will oversee the Company's response to high priority audits/market conduct examinations (MCEs) initiated by commercial regulators and have responsibility for monitoring audit progress, addressing bottlenecks, and escalating critical issues to leadership. This senior-level position is integral to ensuring the organization's compliance with regulatory requirements and maintaining the integrity of OptumRx's operations. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: * Oversee and manage audits and MCEs conducted by state regulatory agencies across OptumRx's commercial business * Monitor ongoing audits, identify and address bottlenecks, and escalate critical issues to senior leadership as needed * Support the development and maintenance of MCE reporting to governance and risk management stakeholders * Enhance and refine exam management standards and processes * Lead the preparation, coordination, and submission of responses to regulatory audit/ MCE requests and findings, ensuring timely and accurate completion of all documentation and communication * Serve as the primary point of contact for regulatory agencies during the audit process. Maintain effective communication with internal stakeholders to keep them informed of audit status and resolutions * Partner with the business and colleagues across legal, compliance, and regulatory affairs to develop appropriate corrective action plans and successfully resolve audits * Support root cause analysis of confirmed audit findings in coordination with business teams 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: * 8+ years of Market Conduct Examination/Department of Insurance expertise (i.e. state audits, market conduct exams, surveys and investigations) * 8+ years of experience in audit (operational, financial, and/or IT related) * 8+ years of experience in a healthcare regulatory environment * Project management experience * Experience working well under tight timelines and adapting to change in a fast-paced and team-oriented environment * Intermediate level of proficiency with MS Word, Excel and PowerPoint * Ability to travel domestically on occasion Preferred Qualifications: * Professional certification (e.g., CPA, CIA, CFE) * 8+ years of experience with HIPAA, state and privacy laws * Experience working with the pharmacy and pharmacy benefits management industries * Sound understanding of regulatory standards and audit practices * Proven superior oral, written communication and interpersonal skills * Proven superior analytical, organizational and problem-solving skills * All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy The salary range for this role is $124,500 to $239,400 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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. 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. UnitedHealth Group 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. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Headquartered in Richfield, Ohio, Vanliner Insurance Company is a member of Great American Insurance Group. For over 30 years, Vanliner has grown to become the country's top insurance provider for the moving and storage, parcel and home delivery industries. Our mission since day one, has been to provide first-class insurance products and unparalleled customer service to all of our customers. Our success is driven by the expertise, innovation and commitment to customer service that our employees provide. If you are ready to join an engaging and driven team such as ours, we would love to hear from you! Since 1989, National Interstate has specialized in serving the insurance needs of the wheels-based transportation industry. Our steadfast focus on developing niche expertise in product design, loss control and claim services has made National Interstate one of the most respected names in commercial transportation insurance today. (****************** Vanliner is looking for a Loss Control Consultant to join their team. This individual will work fully remote from the USA. Essential Job Functions and Responsibilities Conducts complex risk assessments for insured properties and operations to inform underwriting decisions. Identifies potential risk exposures and formulates strategic recommendations to mitigate identified risks. Interprets and analyzes loss data to identify patterns and designs and implements loss prevention programs tailored to client-specific needs. Provides advanced technical guidance and conducts training for clients on safety practices and regulatory compliance. Monitors the effectiveness of loss control measures and makes strategic adjustments to enhances outcomes as needed. May have responsibility for performance and coaching of staff and may have a participatory role in decisions regarding talent selection, development, and performance management for direct reports. Performs other duties as assigned. Job Requirements Education: Bachelor's Degree in Risk Management and Insurance, Safety Engineering, or a related field or equivalent experience. Prefer candidate to reside in MN (Twin Cities) Experience: Generally, a minimum of 9 years of experience in loss control, risk management, or a related field within the property and casualty insurance industry. Continuing progress toward and/or the completion of a professional designation preferred, such as Certified Safety Professional (CSP), Associate in Risk Management (ARM), Certified Fire Protection Specialist (CFPS), Certified Safety and Health Management (CSHMS), Associate Loss Control Management (ALCM) or Occupational Health and Safety Technician (OHST).Scope of Job/Qualifications: Works on assignments of moderate to higher technical and logistical complexity. Displays advanced analytical, risk assessment, and problem-solving skills. Maintains advanced knowledge of company policies and industry laws and regulations. Excellent interpersonal and communication skills and results-oriented consultative skills. Strong analytical skills with the ability to use data to analyze situations, identify problems, and develop effective solutions. The wage range for this job is based on role, level, and location. Within the range, individual pay takes into account a variety of factors that are considered in making compensation decisions including but not limited to skills, education, training, licensure and certifications, experience of the candidate, the role's scope, complexity, and other business and organizational needs. We offer a competitive Total Rewards package, including medical, dental, and vision plans starting on day one, PTO, paid holidays, commuter benefits, an employee stock purchase plan, education reimbursement, paid parental leave/adoption assistance, and a 401(k) plan with company match. These benefits are available to eligible full-time and part-time employees. Your recruiter can provide more details about our total rewards and specific compensation ranges during the hiring process. Company: NIIC National Interstate Insurance Company Salary Range: $75,000.00 -$95,000.00 Benefits: Compensation varies by role, position level, and location. Individual pay is influenced by skills, education, training, certifications, experience, and the role's scope and complexity, along with business needs. We offer a competitive Total Rewards package, including medical, dental, and vision plans starting on day one, PTO, paid holidays, commuter benefits, an employee stock purchase plan, education reimbursement, paid parental leave/adoption assistance, and a 401(k) plan with company match. These benefits are available to eligible full-time and part-time employees. Your recruiter can provide more details about our total rewards and specific compensation ranges during the hiring process.

Summary of Job Oversee and actively participate in quality improvement projects. Contribute to the overall success of Quality Programs by promoting advancing the department mission of effectively managing members and improving health outcomes. Serve as the Quality Management liaison for internal and external partners for projects and improvement initiatives. Subject matter knowledge expert with regards to quality improvement & reporting. Responsibilities * Work directly with business partners to plan, implement, and oversee ongoing operational execution of quality improvement projects and action plans (HEDIS, CAPHS, and HOS) to meet corporate business goals for Medicare, Medicaid, QHP, and Commercial product lines. * Support the execution of centrally developed and data-driven strategic plans. * Assist in leading cross-functional teams for collaboration on HEDIS, CAHPS, HOS, Pharmacy, and Enterprise metrics. * Serve as a point of contact for quality vendors: develop and share target lists; provide support in monitoring performance against established Service Level Agreements; provide a communication bridge between the company/line(s) of business and the vendors. * Manage ongoing quality programs including Member Rewards & Incentives, Provider Quality Incentives, and addressing Health Disparity initiatives. * Provide subject matter expertise and support on all quality metrics to key stakeholders. * Support NCQA/CMS/HEDIS/CAHPS/HOS and other regulatory requirements that apply to quality programs. * Work with the data team to conduct analysis and reporting as needed on initiatives designed to impact quality performance to provide insight to future projects. * Develop annual performance improvement projects; analyze project data; and ensure completion of the finished product(s) including the development of year-end report(s). * Develop methodologies for quality program assessment (ROI and proof points of program outcomes, etc.) Qualifications * Bachelor's Degree; Master's Degree (Strongly Preferred) * Project Management/Vendor Management certification (Preferred) * 5 - 8 years of relevant, professional work experience (Required) * 3 - 5 years of Quality and/or program management experience in a managed care organization (Required) * Additional years of experience/specialized training/certifications may be considered in lieu of educational requirements (Required) * Experience in researching, developing, implementing, and assessing results of metrics and analytics (Required) * Understanding of contractual or compliance related SLAs (Required) * Ability to successfully manage multiple projects/tasks with competing priority levels and deadlines (Required) * Experience and knowledge with HEDIS/QARR, CAHPS, CMS Star Ratings, and Accreditation (Required) * Proficient in MS Office - Word, PowerPoint, Excel, Outlook (Required) * Excellent communication skills - verbal, written, presentation, interpersonal, active listening (Required) * Working knowledge of MS Access (Preferred) Additional Information * Requisition ID: 1000002308_02 * Hiring Range: $72,000-$138,000

**Resp & Qualifications** **PURPOSE:** This position oversees and directs the work of analysts in a supervisory capacity. This position is responsible for implementing departmental strategy and policies in order to meet team goals, as well as making recommendations to Actuarial management where appropriate. The primary responsibilities of this position includes but not limited to 1. Identify cost of care opportunities for medical management for all lines of business. 2. Work cross-functionally with Health Economics, Financial Planning & Analysis, and Clinical Management teams. 3. Support the evaluation, monitoring, and reporting of the initiatives' performances. **ESSENTIAL FUNCTIONS:** + Responsible for coordinating the activities analysts ensuring accurate and timely release of requested analyses and reports. Responsible for providing training, development, documenting performance issues, if needed, and monitoring and enforcing adherence to Company policies. The Supervisor sets objectives, writes and deliveries performance feedback and appraisals, promotions, salary increases, hiring and disciplinary communications. + Responsible for coordinating the development and extensive analytical review of various actuarial analyses such as IBNR, trend, rating actions, and valuation work in support of departmental objectives. This includes supporting the junior team members, working with other areas within the Company, producing presentations for senior management and communicating status of deliverables to the department management. + Oversee calculations, serve as Subject Matter Expert (SME), direct the workflow and ensure that sound actuarial and financial methods are used by Analysts. **SUPERVISORY RESPONSIBILITY:** This position manages people. **QUALIFICATIONS:** **Education Level:** Bachelor's Degree in Actuarial Science, Finance, Mathematics or related field OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience. **Experience:** 3 years health actuarial experience with demonstrated leadership. **Knowledge, Skills and Abilities (KSAs)** + Ability to organize to task completion, plan and prioritize work. + Must demonstrate flexibility, innovation and problem-solving skills and resourcefulness. + Ability to express technical and financial analysis in a clear, concise manner on both written and oral form. + Must possess negotiating and consulting skills. + Possesses highly developed analytical skills and excellent interpersonal and communication skills, both written and oral. + Effectively convey actuarial and/or underwriting issues to a diverse audience., Advanced **Licenses/Certifications** : Associate of the Society of Actuaries (ASA) Upon Hire Required. Salary Range: $97,344 - $200,772 **Salary Range Disclaimer** The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** Actuarial Member Analytics and **Equal Employment Opportunity** CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. **Where To Apply** Please visit our website to apply: ************************* **Federal Disc/Physical Demand** Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. **PHYSICAL DEMANDS:** The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. **Sponsorship in US** Must be eligible to work in the U.S. without Sponsorship. \#LI-CB1 REQNUMBER: 20716

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start **Caring. Connecting. Growing together.** Individual and Family Plans (IFP) is a growing business within UnitedHealthcare. The Coding Consultant for IFP Product provides medical coding expertise to support internal policy development, benefit definition and accurate benefit configuration. They research and interpret healthcare correct coding using regulatory requirements and guidance related to CMS and CPT/AMA, review other major payer policies, and use internal business rules and policies to prepare written documentation in support of benefit configuration. The Coding Consultant for IFP Product possesses an overall understanding of all coding principles, including facility and physician coding and dental coding. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Serve as a coding resource and provide coding expertise and guidance for IFP Product and configuration partners + Develop and maintain code sets used to define IFP medical and specialty benefits (hearing, vision, dental), seeking and promoting enterprise alignment when appropriate + In partnership with Product and Clinical partners, ensure IFP sources of truth for benefit administration/configuration (e.g., benefit configuration guidelines, Pay Code Status lists, etc.) contain accurate and complete CPT, HCPCS, Revenue, CDT and/or ICD-10 codes to support benefit intent + Monitor annual and quarterly code updates, identify impacts to IFP Product documentation, and update documentation as needed + Ensure adherence to state and federal policies/mandates, reimbursement policies and contract requirements + Facilitate meetings with key partners, including: Clinical, Operations, Claims, Configuration and others to achieve benefit design coding solutions + Research and interpret correct coding guidelines and internal business rules to respond to benefit inquiries and issues + Identify and recommend opportunities for cost savings and improving outcomes 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:** + 3+ years of medical coding experience in a health insurance product implementation, benefit/coverage policy development, benefit configuration, or claims role + Have and maintain one or more of the following coding credentials: CPC, CCS-P, CCS, CPMA or equivalent + Experience analyzing data and/or regulatory requirements, problem solving, and providing fact-based recommendations or make decisions based on analysis + Experience performing clinical coverage review of post-service (pre-or-post payment) of claims requiring interpretation of state and federal mandates; certificates of coverage, medical and reimbursement policies, coding requirements and consideration of relevant clinical information on claims + Experience multi-tasking, prioritizing, and managing time efficiently across multiple work partners + Knowledge of Commercial medical insurance benefits **Preferred Qualifications:** + Experience with health insurance reimbursement policy + Familiarity of SNOMED, LOINC, NDC and CDT + Experience in the plan build/plan configuration + Proficient in Microsoft Word, Excel, PowerPoint, etc. + Demonstrated ability to work collaboratively and influence others to drive timely decisions + Ability to work independently, or as an active member of a team + Accurate and precise attention to detail + Excellent analytical, verbal and written communication skills *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy The salary range for this role is $89,800 to $176,700 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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. **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._ _UnitedHealth Group 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._ _UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment._