Senior Compliance Analyst - Remote

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.

The Flag Management Senior Compliance Analyst is responsible for performing several different tasks that are necessary to enable Fraud and Abuse provider centric claim reviews, F&A hard deny flag placement and active flag monitoring. These may include flag reporting, managing flag submissions, handling claims platform approval and notification processes, serving as the point of contact for flag submitters, understand historical flag activity and performing in-depth analysis of flag issues. Managing data integrity and loading to business partner areas and tools of F&A hard deny flag information. Project management of escalated issues coming from F&A hard deny committee governance, Legal and Senior Leadership. Managing process flow symmetry between the business partner workflow tools and flag management workflow tools. Design and configure new processes to address gaps found when working with F&A flagged providers and appeals. The Flag Management Senior Compliance Analyst scope of work is dependent on the requests from other departments and this individual needs to shift gears effectively to handle changing demands. The Flag Management Senior Compliance Analyst shall be skilled in navigating a fast-paced environment with multiple concurrent priorities while maintaining a precise attention to detail.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities:

• Support Flag Management as a process analyst and Subject Matter Expert
• Ability to research and analyze flags data
• Escalation support for flag and platform related issues
• Support higher flag complexity flag initiatives
• Research and contribute to process enhancements and initiatives and integrate into P&P and Job Aids
• Maintain accurate, current, and thorough flag information in RAD flag tracking system
• Develop goals and objectives, track progress and adapt to changing priorities
• Effectively communicate in both written and verbal forms
• Partner to design, implement and leverage new enhancements to overall claim system flag functionality, oversight of active flag activity and governance processes for flag action requests
• Knowledgeable with all controllable and non-controllable flag types and associated platforms.
• Design and publish P&P and Job Aids for flag governance meetings and flag management workflow tools
• Daily Team communication and communication with impacted users of flag management workflow tools
• Weekly communication with impacted business areas (SIU's, Financial Services, Appeals, Claim Operations, Analytics, Optum Pre Pay, Compliance and Regulatory)
• Facilitate ongoing governance meetings with business partners in flagging and analytics to ensure collaboration and efficiencies of current and future processes
• Develop and maintain working relationships with individuals across a variety of functional areas
• Be able to prioritize and balance multiple priorities

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.

Years of post-high school education can be substituted/is equivalent to years of experience.

Required Qualifications:

• High School Diploma or GED
• 2+ years of work experience with healthcare and/or regulatory related employment
• Claims platform experience in using 3 or more of the following applications: UNET, COSMOS, CPW, ISET, NICE, Facets, Oxford, TIPs Historical, AO Database
• Demonstrated expertise in prepay flag processes
• Demonstrated expertise in problem solving and researching issues independently to completion. If guidance is needed, outlines the issues, research completed and provide recommendations
• Demonstrated basic level of proficiency in Microsoft Excel and Word or minimum of 5+ years of experience
• Proven excellent time / project management, problem solving, organizational, and analytical skills

Preferred Qualifications:

• Demonstrated basic level of knowledge in health care policies, procedures, and documentation standards or 5+ years of experience
• Specialized knowledge/training in healthcare FWA investigations

*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.