Claims Business Process Consultant - Braintree, MA

UnitedHealth Group is an innovative leader in the health and well-being industry, serving more than 55 million Americans. Through our family of companies, we contribute outstanding clinical insight with consumer-friendly services and advanced technology to help people achieve optimal health.OptumHealth improves the quality and efficiency of health care through personalized, caring and lifelong services for consumers and employers.   Position Description:   Positions in this function are responsible for all related aspects of claim system processes and claim business rules. Includes claims systems utilization, capacity analyses/planning and reporting. Includes claims-related business and systems analysis as well as ensuring data integrity, data security and process optimization.   Primary Responsibilities:Provide expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing, and adjusting claims. Authorize the appropriate payment or refer claims to investigators for further review. Conduct data entry and re-work; analyze and identify trends and provide reports as necessary. Manage and is accountable for professional employees and/or supervisors. Impact of work is most often at the local level. Set team direction, resolve problems, and provide guidance to members of own team. May oversee work activities of other supervisors. Adapt departmental plans and priorities to address business and operational challenges. Influence or provide input to forecasting and planning activities. Product, service, or process decisions are most likely to impact multiple groups of employees and/or customers (internal or external). Generally work is self-directed and not prescribed.Qualifications: High school diploma required Bachelors strongly preferred. 4 years supervisory experience in a client-facing role within a customer service claims environment is required. Additional healthcare experience in provider operations, grievances, or client account management is highly preferred. Solid experience with ICD-9 and CPT coding required. Claims certifications strongly desired.Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V UnitedHealth Group is a drug-free workplace.  Candidates are required to pass a drug test before beginning employment.