EmblemHealth jobs - 1,101 jobs

Summary of Job Responsible for management of all Provider Claims resolutions; ensure that all claims are handled timely and accurately. Maintain thorough knowledge of all provider contracts and translate language into Emblem terminology, with an understanding of Emblem's various processing systems including claims and provider systems to evaluate ability to process claims according to contracts. Serve as a subject matter expert in all areas of contract configuration, fee schedules/groupers, and rate reimbursement. Provide recommendations for process improvements; manage process change implementations. Fully comprehend the downstream impact of loaded rates within EmblemHealth's full claims reimbursement cycle. Responsibilities * Oversee a unit of claims experts to review, reconcile and resolve claims inquiries, handling all claims inventory, appeals and special handling: hire, develop, mentor, train staff; clearly communicate expectations; monitor and provide feedback; ensure appropriate levels of staffing; complete performance reviews. * Manage performance of team for claims quality; implement corrective action plans identified for areas of direct and non-direct controls. * Responsible for all aspects of aging inventories of Claims and Special Handling requests. * Ensure that all claims are processed accurately and timely in accordance with regulatory and corporate metrics and requirements; coordinate with multiple departments to review the need for claim adjustments due to contract/provider/system issues. * Present and report daily, weekly and monthly status and trends on AR Review Specialists production, quality, and claims inventory levels; offer recommendations and submit corrective action plans on improvement and consistency. * Analyze and trend inventories, performance results, and requests to determine root cause. Evaluate opportunities to improve the handling and routing of claims using workflow system. * Work in conjunction with other operating units to analyze results and identify areas for process and quality improvement while providing timely feedback to stakeholder functional units. * Drive process, quality and high-performance culture that ensures timely and accurate adjudication of claims connected to NetworX, TruProvider Linkage and Claim Engines. * Communicate and collaborate with key/oversight area such as Grievance & Appeals, Provider Network Management, Information Technology, external vendors and Vendor Management to effectively develop and implement business solutions. * Perform other duties/tasks as directed or required. Qualifications * Bachelor's degree, preferably in a business, healthcare or operations related field, Master's preferred. * 5 - 8 years' relevant work experience (Required) * 3 - 5 years of experience working in a health care delivery system (Required) * Detail Oriented; analytical ability; problem-solving skills (Required) * Strong proficiency in Microsoft Visio, Excel, and Word (Required) * Proven ability to identify and continuously enhance efficiencies associated with Network operations (Required) * Ability to develop, use, interpret and apply key business metrics (Required) * Ability to organize and lead key initiatives (Required) * Strong written and verbal communication skills; ability to effectively communicate with all types / levels of audiences (Required) Additional Information * Requisition ID: 1000002828 * Hiring Range: $77,760-$149,040

Become a part of our caring community and help us put health first The Medical Director relies on medical background and reviews health claims. The Medical Director work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors.

Become a part of our caring community and help us put health first The Senior Program Delivery Professional strategically identifies, develops, and implements programs that influence providers, members or market leadership towards value-based relationships and/or improved quality metrics. The Senior Program Delivery Professional work assignments involve moderately complex to complex issues where the analysis of situations or data requires an in-depth evaluation of variable factors. The Program Delivery Professional - IHWA Interoperability plays a key role in driving seamless data integration and collaboration within the In-Home Health and Wellbeing Assessment (IHWA) team and across interoperability initiatives. Serving as a business subject matter expert (SME), this individual partners closely with internal and external stakeholders, as well as the Interoperability team, to advance program objectives. Key responsibilities include collaborating with leaders on implementation planning, reviewing and communicating program results, and contributing to the ongoing improvement of processes and automation. The role also begins to influence departmental strategy and requires independent decision-making on moderately complex to complex technical matters related to project components. Work is performed without direct supervision, with considerable latitude in determining objectives and approaches to assignments. The ideal candidate demonstrates a collaborative approach, a strong interest in technology solutions, and a commitment to continuous process improvement. Use your skills to make an impact Required Qualifications Minimum three, (3) years of IT project management or business process automation, experience in technology solutions. Excellent communication skills, both oral and written Proven experience in interoperability or data integration within a healthcare or technology setting. Strong problem-solving skills with demonstrated success in process improvement initiatives and process automation. Familiarity with various technology solutions and interest in exploring new innovations. Excellent collaboration, and stakeholder management abilities. Experience with managing and monitoring successful and impactful projects. Self-starter with the ability to work independently and as part of a team. Futuristic and broad thinker with attention to detail and downstream impacts. Preferred Qualifications Bachelor's degree in Information Technology, Computer Science, Information Systems, or a related field. Experience with EHR integration or usage. Experience with AI integration. Experience automating business processes. PMP certification a plus Knowledge and experience in health care environment/managed care Strong analytical skills Workstyle: Open for Hybrid or Remote Work at Home Location: U.S. Schedule: 8:00 AM - 5:00 PM Eastern Time Monday through Friday Travel: occasional onsite as business needs require. Work at Home Guidance To ensure Home or Hybrid Home/Office employees' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office employees must meet the following criteria: At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is required; wireless, wired cable or DSL connection is suggested. Satellite, cellular and microwave connection can be used only if approved by leadership. Employees who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. Humana will provide Home or Hybrid Home/Office employees with telephone equipment appropriate to meet the business requirements for their position/job. Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information. SSN Alert Humana values personal identity protection. Please be aware that applicants may be asked to provide their Social Security Number, if it is not already on file. When required, an email will be sent from ******************** with instructions on how to add the information into your official application on Humana's secure website. Interview Format As part of our hiring process for this opportunity, we will be using an interviewing technology called HireVue to enhance our hiring and decision-making ability. HireVue allows us to quickly connect and gain valuable information from you pertaining to your relevant skills and experience at a time that is best for your schedule. Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. Scheduled Weekly Hours 40 Pay Range The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $86,300 - $118,700 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. Description of Benefits Humana, Inc. and its affiliated subsidiaries (collectively, “Humana”) offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities.Application Deadline: 01-08-2026 About us Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. Equal Opportunity Employer It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment.

**Become a part of our caring community and help us put health first** The Senior Coding Educator identifies opportunities to improve provider documentation and creates an education plan tailored to each assigned provider. The Senior Coding Educator is responsible for creating and executing the risk adjustment strategy for each provider groups. + Analyzes data and reporting and provides educational sessions with providers aimed at quality of care, documentation and coding improvements. + Collaboration with relationship owners and HQRI + Research data and workflow processes and arranges educational sessions with providers aimed at quality of care and documentation improvements. + Monitor and develops strategy with Coding educator and leader, tailor's provider group webinars and discussions based on various Risk Adjustment topics. **Use your skills to make an impact** **Required Qualifications** + AAPC CPC (Certified Professional Coder) Certification + 2 or more years of medical record review knowledge + 2 or more years of risk adjustment provider education + Familiar with coding guidelines (i.e. ICD-9/ICD-10) + Comprehensive knowledge of MS Word, Excel and PowerPoint + Analyzing Data to drive process improvement + Experience with public speaking and presentation skills **Preferred Qualifications** + Bachelor's degree + Certified Risk Coder (CRC) + Experience interacting with healthcare providers + Ability to work independently + Medicare Risk Adjustment knowledge + Analyzing data to build unique education strategies in PowerBi **Additional Information** **Department Hours: 7am to 5pm EST** Work at home - with ability to travel (up to 25% to surrounding provider offices) **Additional Information** As part of our hiring process, we will be using an exciting interviewing technology provided by HireVue, a third-party vendor. This technology provides our team of recruiters and hiring managers an enhanced method for decision-making. If you are selected to move forward from your application prescreen, you will receive correspondence inviting you to participate in a pre-recorded Voice Interview and/or an SMS Text Messaging interview. If participating in a pre-recorded interview, you will respond to a set of interview questions via your phone. You should anticipate this interview to take approximately 10-15 minutes. If participating in a SMS Text interview, you will be asked a series of questions to which you will be using your cell phone or computer to answer the questions provided. Expect this type of interview to last anywhere from 5-10 minutes. Your recorded interview(s) via text and/or pre-recorded voice will be reviewed and you will subsequently be informed if you will be moving forward to next round of interviews. **Work at Home Guidance** To ensure Home or Hybrid Home/Office associates' ability to work effectively, the self-provided internet service of Home or Hybrid Home/Office associates must meet the following criteria: + At minimum, a download speed of 25 Mbps and an upload speed of 10 Mbps is recommended; wireless, wired cable or DSL connection is suggested + Satellite, cellular and microwave connection can be used only if approved by leadership + Associates who live and work from Home in the state of California, Illinois, Montana, or South Dakota will be provided a bi-weekly payment for their internet expense. + Humana will provide Home or Hybrid Home/Office associates with telephone equipment appropriate to meet the business requirements for their position/job. + Work from a dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information Internal- If you have additional questions regarding this role posting, please send them to the Ask A Recruiter persona by visiting go/vivaengage and searching Ask A Recruiter! Please be sure to provide the requisition number so we may be able to research your request quicker. \#LI-BB1 Travel: While this is a remote position, occasional travel to Humana's offices for training or meetings may be required. **Scheduled Weekly Hours** 40 **Pay Range** The compensation range below reflects a good faith estimate of starting base pay for full time (40 hours per week) employment at the time of posting. The pay range may be higher or lower based on geographic location and individual pay will vary based on demonstrated job related skills, knowledge, experience, education, certifications, etc. $71,100 - $97,800 per year This job is eligible for a bonus incentive plan. This incentive opportunity is based upon company and/or individual performance. **Description of Benefits** Humana, Inc. and its affiliated subsidiaries (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart healthcare decisions for you and your family while also knowing your life extends outside of work. Among our benefits, Humana provides medical, dental and vision benefits, 401(k) retirement savings plan, time off (including paid time off, company and personal holidays, volunteer time off, paid parental and caregiver leave), short-term and long-term disability, life insurance and many other opportunities. **About us** Humana Inc. (NYSE: HUM) is committed to putting health first - for our teammates, our customers and our company. Through our Humana insurance services and CenterWell healthcare services, we make it easier for the millions of people we serve to achieve their best health - delivering the care and service they need, when they need it. These efforts are leading to a better quality of life for people with Medicare, Medicaid, families, individuals, military service personnel, and communities at large. **Equal Opportunity Employer** It is the policy of Humana not to discriminate against any employee or applicant for employment because of race, color, religion, sex, sexual orientation, gender identity, national origin, age, marital status, genetic information, disability or protected veteran status. It is also the policy of Humana to take affirmative action, in compliance with Section 503 of the Rehabilitation Act and VEVRAA, to employ and to advance in employment individuals with disability or protected veteran status, and to base all employment decisions only on valid job requirements. This policy shall apply to all employment actions, including but not limited to recruitment, hiring, upgrading, promotion, transfer, demotion, layoff, recall, termination, rates of pay or other forms of compensation and selection for training, including apprenticeship, at all levels of employment. Humana complies with all applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, sex, sexual orientation, gender identity or religion. We also provide free language interpreter services. See our ***************************************************************************

Optum NY, (formerly Optum Tri-State NY) is seeking a Otolaryngologist / ENT Specialist to join our team in Middletown, NY. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone. At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together. Position Highlights * Physician-led, patient centered team-based supportive care environment * Moderate scheduling templates promoting Work and Life Balance * Educate and empower your patients to take ownership of their health * Full complement of support teams to assist with patient care * Supplemental Income, Growth into Leadership, and Teaching Opportunities * Independence in practice with strong cross-functional team providing patient-centric care with enough volume to keep you busy from day one * Treat a wide range of conditions including, but not limited to: hearing loss, sleep apnea, sinusitis, vertigo, chronic sore throats, tonsilitis, thyroid disorders, and tinnitus in both children and adults * Perform surgeries for thyroid and parathyroid; and expectations of reduced turnaround times for parathyroidectomies with rapid PTH testing added Responsibilities: * Provide comprehensive consultations by evaluating patient conditions and screening for diseases related to the Ear, Nose, and Throat * Utilize patient medical history as part of initial assessments and prescribing of medication for the treatment of any conditions applicable * Perform non-invasive surgical procedures of the thyroid and parathyroid * Frequently Performed Procedures include: Tonsillectomy, Adenoidectomy, Ear Tub Placement, Sinus Surgery (including Balloon Sinuplasty), Septoplasty, Thyroidectomy, Parathyroidectomy, and Vocal Cord Surgery What makes an Optum Career different? * As the largest employer of Physicians in the country, we have a best-in-class employee experience and enable you to practice at the top of your license * We believe that better care for clinicians equates to better care for patients, and provide resources and support * We are influencing change on a national scale while still maintaining the culture and community of our local care organizations * We grow talent from within. No matter where you want to go- geographically or professionally- you can do it here Compensation & Benefits Highlights: * Competitive compensation -guarantee, quality and productivity bonus incentives * Robust retirement package including employer funded contributions * Loan repayment support programs * Employee Stock Purchase Plan (ESPP) * Company paid malpractice insurance with tail coverage * Physician partnership & incentive opportunities with Optum * Career Growth and Development support * You will have access to collaborate in local and national clinical and advisory councils, a network of mentors, and the ability to attend annual clinical & cultural related events and forums. At Crystal Run Health, a part of Optum, we are focused on fostering professional growth, providing the latest technologies, state-of-the-art facilities and a collegial environment that embraces innovation and diversity. As one of the largest private employers in the region, we understand the importance of a healthy work-life balance, offering flexible scheduling, excellent benefits, competitive compensation, and growth opportunities. Together, we're making health care work better for everyone. 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: * Unrestricted licensure in the state of (NY) at time of employment * Board Certification or board eligibility in Otolaryngology * Active and unrestricted DEA license or ability to obtain prior to start Compensation for this specialty generally ranges from $350,500 - $628,000. Total cash compensation includes base pay and bonus and is based on several factors including but not limited to local labor markets, education, work experience and may increase over time based on productivity and performance in the role. We comply with all minimum wage laws as applicable. 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. OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

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 DBA is responsible for the overall database delivery of the Enterprise Data Warehouse for the Medicaid agency. It is a critical role involving expertise in working with Medicaid data itself, security, supporting and maintaining hardware and software, and ensuring we are achieving optimal performance. For example, the DBA is expected to provide a wide range of expertise including the ability to help a user to fetch data (requiring business knowledge) and the technical ability to support a major Teradata upgrade. This role requires regular onsite presence in Springfield, Illinois to perform backup/restore and support onsite maintenance by Teradata (and its subcontractors). This position will be part of our Data Engineering function and data warehousing and analytics practice. Data Engineering Functions may include database architecture, engineering, design, optimization, security, and administration; as well as data modeling, big data development, Extract, Transform, and Load (ETL) development, storage engineering, data warehousing, data provisioning and other similar roles. Responsibilities may include Platform-as-a-Service and Cloud solution with a focus on data stores and associated eco systems. Duties may include management of design services, providing sizing and configuration assistance, ensuring strict data quality, and performing needs assessments. Analyzes current business practices, processes and procedures as well as identifying future business opportunities for leveraging data storage and retrieval system capabilities. Manage relationships with software and hardware vendors to understand the potential architectural impact of different vendor strategies and data acquisition. May design schemas, write SQL or other data markup scripting, and helps to support development of Analytics and Applications that build on top of data. Selects, develops, and evaluates personnel to ensure the efficient operation of the function. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: * Manage, monitor, and maintain OnPrem Teradata hardware/software including patches, replacements, and upgrades with support from Teradata * Support data governance, metadata management, and system administration * Plan and execute tasks required to ensure the Teradata system is operational including occasional evening and weekend support for Teradata maintenance * Provide direction to developers on Operational, Design, Development, and Implementation projects to ensure best use of the Teradata system including review/approval of database components (such as tables, views, SQL code, stored procedures) * Performing database backup and recovery operations - using the BAR DSA and NetBackup * Developing proactive processes for monitoring capacity and performance tuning * Providing day-to-day support for the EDW users problems like job hands, slowdowns, inconsistent rows, re-validating headers for tables with RI constraints, PPIs, and configuration * Maintaining rules set in the Teradata Active System Management (TASM) and supporting workload management * Maintaining the Teradata Workload Manager with the proper partitions and workloads based on Service Levels * Supporting the database system and application server support for the Disaster Recovery (DR) build/test, annual drill, and quarterly maintenance as needed * Actively monitoring the health of the Teradata system and Teradata Managed Servers (TMS) using Viewpoint and other tools and application servers and make preventive or corrective actions as needed * Maintaining access rights, role rights, priority scheduling, and reporting using dynamic workload manager, Database Query Log (DBQL), usage collections and reporting of ResUsage, AmpUsage, and security administration etc. * Coordinating with the team and customers in supporting database needs and making necessary changes to meet the business, contractual, security, performance, and reporting needs * Supporting internal or external audit process and address vulnerabilities or risk proactively * Prepare and support IRS and internal audit * Coordinating with Teradata to perform Teradata system hardening and delivery of Safeguard Computer Security * Evaluation Matrix (SCSEM) Reports as needed, addressing issues in the hardening and vulnerability scan report * Generating and maintaining capacity management, Space, and CPU reports on analyzing the Spool, CPU, I/O, Usage, and Storage resources and proactive monitoring to meet performance and growth requirements * Reviewing and resolving Teradata alerts and communicating any risk / issues or impact to the management, team, and business users through appropriate communication strategy * Effectively reporting status, future roadmap, proactive process improvements, automation, mitigation strategies, and compensating controls to the management and clients * Leading database or data related meetings and projects/activities delivering quality deliverables with minimal supervision/direction * Sharing knowledge, coaching/mentoring other members in the team for backups * Performing additional duties that are normally associated with this position, as assigned * Responsible for front-end tool (OpenText Bi-Query) and model maintenance and administration 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: * 7+ years of experience as a Teradata DBA on Version 15+ (preferably 17+) and experience leading Teradata major upgrade/floor sweep * 5+ years of experience as primary/lead DBA with solid leadership and presentation skills * 5+ years of experience writing complex SQL using SQL Assistant/Teradata Studio * 3+ years of experience with Teradata 6800/1800 system or IntelliFlex * 3+ years of experience extracting, loading, and transforming structured/unstructured data using Teradata Utilities (FastLoad, Multiload, FastExport, BTEQ, TPT) in a Unix/Linux environment * 3+ years of experience performance tuning in a large database (>5TB) or data warehouse environment, using advanced SQL, DBQL and Explain plans * 3+ years of experience analyzing project requirements and developing detailed database specifications, tasks, dependencies, and estimates * 3+ years of experience identifying and initiating resolutions to customer facing problems and concerns associated with a query or database related business need * Data warehouse or equivalent system experience * Demonstrated excellent verbal/written communication, end client facing, team collaboration, mentoring skills, and solid work ethics * Demonstrated solid culture fit through integrity, compassion, inclusion, relationships, innovation, and performance Preferred Qualifications: * Teradata Vantage Certified Master * 5+ years logical and physical data modeling experience * 5+ years with Erwin or other data modeling software * 3+ years maintaining and creating models using OpenText BI-Query * 3+ years identifying and initiating resolutions to customer problems and concerns associated with a Data Warehouse or equivalent system * 3+ years working with end users/customers to understand requirements for technical solutions to meet business needs * 3+ years collaborating with technical developers to strategize solutions to align with business requirements * 3+ years defining standards and best practices and conducting code reviews * Experience working with project teams in metadata management, data/IT governance, business continuity plan, data security * Experience in Application Server Hardware/Software Administration (Windows/Linux) * Experience working in matrix organization as an effective team player * Experience working in agile environment such as Scrum framework and iterative/incremental delivery/release. * Experience in tools like DevOps and GitHub * Experience with State Medicaid / Medicare / Healthcare applications * Experience working in large Design Development and Implementation (DDI) projects * Experience upgrading to Teradata IntelliFlex * Knowledge/experience with Cloud databases such as Snowflake and migration from on Prem to Cloud project * 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 $110,200 to $188,800 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.

* Provide support and assistance to mainstream Medicare, Medicaid, HARP, Child Health Plus and Essential members telephonically (inbound and outbound) with a variety of non‐clinical healthcare and membership needs: completing health care gaps, health related assessments, and state required applications to ensure continuous eligibility of healthcare coverage. * Facilitate and aid Medicaid, HARP, CHP members as NYS Certified Application Counselor with state redetermination process including educating members on state qualifications, necessary proof of income and associated documents while completing required applications and submission to the state. * Proactively lead, facilitate, and assess member experience through targeted Medicare member outreach, including members with multiple complex issues, grievance and appeal cases as well as access to care challenges to continually improve healthcare performance and consumers assessment of EH ability to provide high quality services. * Navigate and provide direction and guidance during member interactions utilizing extensive knowledge of EmblemHealth's products, complex processes, and multiple systems to enhance member's health journey. * Responsible to grow/increase membership enrollments in value added services: Member Portal, Medicare Rewards, Auto Pay and Paperless through telephonic member interactions, etc. Roles and Responsibilities * Provide seamless care coordination and individual needs assessments from member onboarding and throughout member lifecycle to support Medicare, Medicaid, HARP, and CHP members with care/risk health gaps and health risk assessment. * Provide member assistance with initial and annual health assessments. * Identify members qualifying for Care Management programs and resources and collaborate through referrals to Care Management Team. * Assist, coordinate and schedule members with primary care and specialty visits, tests and necessary screenings. * Intermediary and professional liaison with member and healthcare providers and provider facilities. * Meet state mandated deadlines maintaining and acting with a sense of urgency. * Facilitate and aid Medicaid, HARP, CHP members as NYS Certified Application Counselor with New York State of Health redetermination process including educating members on state qualifications, necessary proof of income and associated required documents while completing application and submission to the state. * Lead and facilitate complex application issues including mixed immigration status households, multi-tax household, family enrollment issues and complex income situations. * Intermediary and professional liaison with the member and New York State of Health for coverage redeterminations including handling and submitting sensitive member information. * Proactively lead, facilitate, and assess member experience through targeted Medicare member outreach, including members with multiple complex issues, grievance and appeal cases as well as access to care challenges to continually improve healthcare performance and consumers assessment to provide high quality services. * Provide guidance, advice, and direction; and engage team members to solve for member issues. * Collaborate and provide feedback to Director of Customer Retention and Loyalty team to understand member pain points and identify opportunities to mitigate. * Onboard newly state assigned members and serve as guide for member plan and benefits. Set member expectations and enroll members in EH value added services including Member Portal, Member Rewards, Auto Pay while identifying member communications preferences including paperless. * Retain members targeted for termination of plan by New York State of Health. Assist and educate members on next steps, required paperwork; and institute temporary plan extensions for resolution. * Retain members targeted for termination of plan due to lack of premium payment. Assist member in payment options and avoid loss of coverage. * Support goals of the department by meeting quarterly with Customer Retention and Loyalty leadership team to review results and discuss ways to continually improve member satisfaction, loyalty, revenue (Quality and Risk Scores) and reduce costs. * Participate in weekly meetings with manager and team members to discuss customer concerns, improvement opportunities (people, processes, and technology), and other company priorities. * Assist, support, and conduct user acceptance testing as appropriate and outside of normal business hours. * Participate in state meetings as needed. * Ongoing learning of EmblemHealth and Connecticare products and services, including any recent changes in business rules or decisions that may impact customer experience. * Perform other duties assigned, directed, or required Qualifications * Bachelor's Degree * Additional experience/specialized training may be considered in lieu of degree requirements required * Must have NYS Certified Application Counselor certification; or obtain certification within 90 days of hire date as a condition of continued employment. Must maintain up‐to‐date, valid certification status to remain employed in the role. * 3 - 5+ years of experience working with members in customer service, medical or managed care environment required * Experience communicating directly with customers, assessing needs, and connecting customers with resources required * Knowledgeable on how to navigate all aspects of medical care and managed care system; health and wellness preferred * Knowledge of healthcare related regulations, processes, services, and products preferred * Ability to demonstrate excellent service knowledge and hospitality required * Technologically savvy, with the ability to quickly learn and navigate different information technology systems required * Flexibility to travel to, and work in a physical office site when needed required * Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.) required * Strong communication skills (verbal, written, presentation, interpersonal) with all types/levels of audience required Additional Information * Requisition ID: 2504M * Hiring Range: $52,000-$92,000

Provide technical, administrative, and logistical support in executing community events for Marketplace Sales to facilitate the selling and engagement functions. Assist with the management of EmblemHealth events, sponsorships, and community activations. Responsible for the daily operation, maintenance, and organization of EmblemHealth's Community Outreach Vehicles (COVs), cargo vans, and RVs at assigned marketing locations. Ensure the Sales Department staff have a professional and functional environment to engage with community members and support enrollment efforts. Principal Accountabilities Sales Operations Enablement: Scout and secure approved parking/event locations within the assigned catchment area. Identify safe and legal space to set up displays and working area. Perform daily setup, breakdown, and transport of marketing equipment (tents, tables, banners, marketing material, supplies, A-Frames, etc.). Support Sales Reps with administrative tasks (distribute flyers and other materials, assist with lead collection). Engage with members of the public to generate or discern interest in speaking with our reps about health insurance. Maintain communication with Fleet and Sales Management, report competitor activity or marketing obstacles. Vehicular: Maintain an efficient, organized, and clean vehicle (interior & exterior). Conduct daily vehicle inspections (complete daily inspection checklist): check and replace or replenish fluids as needed (gas, oil, transmission, windshield wiper, brake fluids, etc.). Perform minor maintenance tasks: check tires, wiper blades, etc., and take necessary actions to ensure safety. Communicate/escalate if more advanced or complex maintenance is required. Responsible for transporting to repair shop (as needed) Transportation: Pick up vehicle from assigned parking location and drive to assigned field location. Lift, pack, and transport marketing equipment, materials, and supplies to field representatives. Comply with DOT and local traffic regulations. At the end of shift, pack up vehicle and return it back to assigned parking location. Unload materials, equipment, and supplies as needed. Miscellaneous: Conduct supply inventory checks and order replenishments as necessary. Safeguard confidential documents and deliver them securely to appropriate staff within 24 hours. Assist in onboarding/training new drivers. Perform other related duties/tasks as directed, assigned, or required. Qualifications Education, Training, Licenses, Certifications Bachelor's Degree. Unrestricted NYS driver's License. Relevant Work Experience, Knowledge, Skills, and Abilities 2 - 3+ years of relevant, professional work experience. Extensive experience driving in various NY neighborhoods. Additional experience/specialized training may be considered in lieu of degree requirement. Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.). Ability to perform minor vehicular maintenance tasks (e.g., checking and replacing wiper fluid, checking oil/fuel levels, checking tires, etc.). Ability to lift and transport materials and equipment weighing up to 100 lbs. Strong communication skills (verbal, written, interpersonal) with all types/levels of audiences. Strong organizational skills; ability to manage and maintain inventories. Prioritizing and problem-solving skills; ability to effectively manage logistical tasks. Must be willing and able to work “off hours” such as evenings, weekends, holidays, etc. as needed. Additional Information

**Optum NV is seeking a Medical Oncology Resident Pathway to join our team in Las Vegas, NV. Optum is a clinician-led care organization that is changing the way clinicians work and live.** **As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone.** At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while **Caring. Connecting. Growing together.** You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Position Highlights:** + **_This is a temporary role intended for physician residents in their final year of training, interested in pursuing a full-time role with our group following completion of residency_** + **_OptumCare will educate and prepare physicians to join our group full time, providing a customized program with exposure to our radiation oncology team as well as Optum as an organization. The commitment requires only a few hours per month maximum_** **_Compensation & Benefits Highlights:_** + **_Physician Resident will receive an adjusted annual salary_** OptumCare Nevada, is Nevada's largest multi-specialty practice, with over 350 physicians and advanced practice clinicians. Our facilities include 22 medical offices, with 13 urgent cares and retail clinics, two lifestyle centers catering to seniors and two outpatient surgery centers. The practice is fully integrated and includes home health, complex disease management, pharmacy services, medical management and palliative care. OptumCare Nevada is actively engaged in population health management, with an emphasis on outcomes, and offers patients compassionate, innovative and high-quality care throughout Nevada. OptumCare Nevada is headquartered in Las Vegas, Nevada. OptumCare Cancer Care is seeking a Radiation Oncology Physician for our Radiation Oncology division located in Las Vegas, NV. This is an outstanding opportunity for a physician 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:** + **_M.D. or D.O_** + **_Transitioning into final year or early into final year of residency/fellowship_** + **_Board Certified/Board Eligible in specialty_** + **_Active unrestricted NV license and DEA or ability to obtain prior to employment_** *All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy **California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Rhode Island, Washington** **or** **Washington, D.C. Residents Only:** The salary range for this role is $33,280 to $41,700 annually. 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. _OptumCare is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations._ _OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment._

2026 Summer Associate Program EmblemHealth is one of the nation's largest not-for-profit health insurers, serving members across New York's communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. Today, our mission is clear: to champion communities and customers first, with a relentless focus on experiences that work for them. We never stop making those we serve our number one priority. Summer Associate Program The Summer Associate Program allows students to collaborate with senior leaders who are committed to growing, developing, and empowering the next generation of healthcare leaders. Summer Associates will have the opportunity to work cross-functionally with Strategy on projects within a group setting across the organization. The Strategy team focuses on corporate development, strategic planning, and strategy implementation. The team partners with business unit and functional leadership across the enterprise to complete market analysis, develop business cases, identify key performance metrics, and take direct responsibility for strategy execution. The team helps leadership establish annual enterprise priorities and support in-year performance management. Program Details * Ten-week paid program: Monday, June 1 - Friday, August 7 * Full-time: 40 hours per week * Hourly rate: $30 per hour * Hybrid Work Schedule: May be asked to come to the office two days a week Requirements * Minimum GPA of 3.0 or above preferred * Undergraduate students (expected graduation between December 2026 to May 2028) * Graduate students (expected graduation between December 2026 to June 2027) * Interest in the healthcare industry * Analytical, collaborative, strong communication, and project management skills Application Period: November 3, 2025 to Friday, January 16, 2026 * All applications must be submitted by 5 PM (EST) on Friday, January 16 * If selected, on-site interviews will be conducted mid February 2026 If you want to be a part of a bigger story, if you want to make a difference in people's lives and the communities around you, and if you think healthcare matters to every one of us - Join us! Additional Information * Requisition ID: 2502Q * Hiring Range: $30/hr

Summary of Job Collaborate with pharmacists to proactively engage health plan members to improve their medication adherence and positively impact health outcomes. Develop and deliver communication to members that is cognizant of cultural, ethnic, and other differences in order to effectively maximize probability of success in modifying behaviors. Play a critical role in facilitating outreach efforts and ensuring timely follow-up to address barriers to adherence. Partner closely with the Quality Pharmacy Team to drive quality performance and enhance member satisfaction. Responsibilities * Engage with members to understand reasons for non-adherence. * Craft and deliver empathetic, culturally sensitive, and solution-oriented support to members during outreach. * Provide a positive member experience by reinforcing the importance of medication adherence and connecting members to appropriate resources. * Identify barriers to adherence and support resolution of common issues such as refill delays, cost concerns, or lack of understanding of medication purpose. * Develop and document outreach efforts while maintaining detailed and accurate records of member interactions to ensure timely and effective communication. * Escalate clinical concerns to pharmacists as needed. * Adhere to all regulatory, privacy, and compliance standards in member communications and data handling. * Ensure all outreach activities are conducted in accordance with organizational policies and clinical protocols. * Work closely with the Quality Pharmacy Team to align outreach strategies with organizational goals and quality initiatives. * Participate in regular team huddles or strategy sessions to share insights and improve outreach effectiveness. * Manage multiple outreach tasks and follow-ups efficiently, ensuring timely and accurate documentation. * Prioritize work based on member needs, outreach schedules, and team objectives. Qualifications * Associates degree; bachelor's degree preferred. * National Pharmacy Technician Certification required, or must be obtained within 6 months of hire date as a condition of continued employment; and certification must be maintained while employed in this role (Required) * 3 - 5+ years of relevant, professional work experience (Required) * 2+ years of pharmacy related experience (Required) * 2+ years of call center customer service experience (Required) * Additional experience / specialized training may be considered in lieu of degree requirement (Required) * Claim system knowledge with ability to analyze pharmacy claims (Required) * Knowledge of Medicare Part D (Required) * Excellent communication skills with employees, practitioners and members regarding verification and explanation of pharmacy benefits (Required) * Excellent organizational, prioritization and time management skills (Required) * Detail oriented with strong analytical, problem solving and follow up skills (Required) * Work independently within a team environment with/little direct supervision (Required) * Demonstrated proficiency using personal computers, MS Office software including Word, Excel, and Access (Required) * Ability to work in a high pace, stress environment (Required) Additional Information * Requisition ID: 1000002753 * Hiring Range: $56,160-$99,360

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 REQUIRES 50% TRAVEL TO PROVIDERS OFFICES*** ***CANDIDATE MUST RESIDE IN STATE OF INDIANA*** Position Purpose: Establishes and fosters a healthy working relationship between large physician practices, IPAs and Centene. Educates providers and supports provider practice sites regarding the National Committee for Quality Assurance (NCQA) HEDIS measures and risk adjustment. Provides education for HEDIS measures, appropriate medical record documentation and appropriate coding. Assists in resolving deficiencies impacting plan compliance to meet State and Federal standards for HEDIS and documentation standards. Acts as a resource for the health plan peers on HEDIS measures, appropriate medical record documentation and appropriate coding. Supports the development and implementation of quality improvement interventions and audits in relation to plan providers. Delivers, advises and educates provider practices and IPAs in appropriate HEDIS measures, medical record documentation guidelines and HEDIS ICD-9/10 CPT coding in accordance with state, federal, and NCQA requirements. Collects, summarizes, trends, and delivers provider quality and risk adjustment performance data to identify and strategize/coach on opportunities for provider improvement and gap closure. Collaborates with Provider Relations and other provider facing teams to improve provider performance in areas of Quality, Risk Adjustment and Operations (claims and encounters). Identifies specific practice needs where Centene can provide support. Develops, enhances and maintains provider clinical relationship across product lines. Maintains Quality KPI and maintains good standing with HEDIS Abstraction accuracy rates as per corporate standards. Ability to travel up to 50% of time to provider offices. Performs other duties as assigned. Complies with all policies and standards. Education/Experience: Bachelor's Degree or equivalent required 3+ years in HEDIS record collection and risk adjustment (coding) required Licenses/Certifications: One of the following required: CCS, LPN, LCSW, LMHC, LMSW, LMFT, LVN, RN, APRN, HCQM, CHP, CPHQ, CPC, CPC-A or CBCS For Managed Health Services - IN -- No license/certification is required 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

REMOTE * Provide the analytical resources necessary for the development of overall pricing and reserve setting strategies. * Lead projects to analyze current rate structures and develop improvements and alternatives. * Coordinate the actuarial staff as needed to support the activities of the affiliates. Responsibilities: * Work closely with Senior Product Management and Finance to analyze financial performance of blocks of business, including membership, trend, and financial analyses. * Identify opportunities to improve product performance in collaboration with all areas of the organization. * Oversee the development and filing of premium rates for all products with the appropriate regulatory authority (e.g., CMS, New York Dep't of Health). * Work closely with Risk Adjustment and other areas to optimize risk adjustment and related programs to increase Emblem's premium revenue for these segments. * Supervise and develop direct reports accountable for Medicare and State Sponsored areas, as well as other staff * Regular attendance is an essential function of the job. Perform other duties as assigned or required. Qualifications: * Bachelor's degree in Actuarial Science, Mathematics, other physical science, or related finance/business degree required * Associate of the Society of Actuaries (ASA) required * 5 - 8+ years relevant professional work experience and/or education required * 4+ years health insurance actuarial experience, preferably in the managed care industry required * Prior management experience (processes and/or staff) preferred * A comprehensive understanding of actuarial principles and methodologies; strong mathematical and analytical skills required * Ability to communicate effectively with Business leaders required * Expert level skills with database, spreadsheet, and analytical software required * Proficiency with MS Office (Word, Excel, Access, PowerPoint, Outlook, Teams, etc.) required * Strong data querying skills using tools such as SQL or SAS Enterprise Guide preferred * Capable with data extraction, simulations, automation required Additional Information * Requisition ID: 1000002831 * Hiring Range: $77,760-$149,040

**Internships at UnitedHealth Group.** If you want an intern experience that will dramatically shape your career, consider a company that's dramatically shaping our entire health care system. UnitedHealth Group internship opportunities will provide a hands-on view of a rapidly evolving, incredibly challenging marketplace of ideas, products and services. You'll work side by side with some of the smartest people in the business on assignments that matter. So here we are. You have a lot to learn. We have a lot to do. It's the perfect storm. Join us to start **Caring. Connecting. Growing together.** You'll be at the intersection of sales and healthcare, about to create the next incredible solution for insurance customers primarily under the age of 65. If you want to advance your learning in a technology environment that's always pushing the envelope, you've come to the right place. The UnitedHealthOne team, part of UnitedHealthcare's thriving family of businesses, is a team of people who are passionate about using consultative sales to help improve the lives of millions and make health care work better for all. Throughout your 6-month Co-op Early Careers internship experience, you'll be licensed and credentialed as an Insurance Professional. You'll be trained on the tools and products, as well as the sales and compliance techniques to serve as a trusted agent for potential customers. In addition, the Co-op also offers networking, collaboration opportunities as well as mentorship from experienced insurance professionals and leaders. The intent of our Co-op program is to provide return internship opportunities or full-time employment opportunities at UnitedHealthOne, depending on eligibility. This Co-op position will be available for the Summer/Fall semester, TBD (unlicensed). If already licensed with an active Life and Health Insurance License when hired The internship will take place from Summer 2026 - mid December 2026. **Hours of the role:** + First 8 weeks 40 hours per week (orientation. Pre-licensing prep, and training will be Monday - Friday 8:00am - 4:45pm ET + Ability to work 40 hours per week during full hours of operation, 8am - 10:45pm ET, based upon business need (orientation, pre-licensing preparation, and training is typically 8:00am - 4:45pm ET for approximately the first 8 weeks; evening & weekends may be required post-training, with notice given on change of hours) **Commitment Expectations:** + Generally, this means that students have limited, additional coursework (0 - 6 credit hours for the fall semester), along with outside commitments that are flexible to the agreed-upon work hours for the duration of the Co-op + This is not a situation where hours and location of work are at the discretion of the student; hours are agreed upon, in advance, with the Co-op supervisor, and work location needs to be a protected health information (PHI) compliant space (no coffee shops or generally other 'open' Wi-Fi networks are to be used) You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on this fulfilling opportunity. **Primary Responsibilities:** + Successfully become licensed in health & life within your resident state** within the first 30 days of Co-op, if not already licensed + Successfully pass FFM (Federally Facilitated Marketplace) and other potential state based exchanged certifications within first 90 days of Co-op + Handle leads from both a dedicated carrier leadsource (UHC) and a multi-carrier leadsource (HealthMarkets) + Receive inbound calls from leadsources and offer available ACA (Affordable Care Act) products based on an established sales process that includes required scripting and highly compliant, needs-based selling + Conduct follow-up calls to consumers who have not yet purchased the product(s) discussed on a previous call, which may include calls made by other licensed agents, to help close the sale + Handle chats with prospective customers according to training and guidelines for the lines of business identified 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:** + Currently pursuing a Bachelor's degree from an accredited college/university + Actively enrolled in an accredited college/university during the duration of the Co-op. Not intended for graduating seniors + Must be eligible to work in the U.S. without company sponsorship, now or in the future, for employment-based work authorization. F-1 visa holders with Curricular Practical Training (CPT) or Optional Practical Training (OPT) who will require visa sponsorship, TN visa holders, current H-1B visa holders, and/or those requiring green card sponsorship will not be considered **Preferred Qualifications:** + Pursuing a degree in Sales, Business, Communication, Healthcare, or Insurance + Intermediate Microsoft Office skills (Outlook, Word, Excel, Powerpoint) + Eagerness to learn about the healthcare system & insurance + Solid communication skills (both written and verbal) + Good problem-solving skills with attention to detail + Ability to work independently with minimal supervision in a fast-paced team environment 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 hourly pay for this role will range from $18.00 to $32.00 per hour 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.** This position is a Medicaid Subject Matter (SME) Expert for the Enterprise Data Warehouse supporting the State Medicaid program. This role requires significant expertise of Medicaid Enterprise System modules and data warehousing or decision support systems. This role provides the guidance and direction to support a large data warehouse implementation and maintenance & operations. The selected SME will provide the required decisions for the business and technical team members to modify, change, enhance or correct within the system, related to claims, provider, and recipient data. Roles in this function will partner with stakeholders to understand data requirements and support development tools and models such as interfaces, dashboards, data visualizations, decision aids and business case analysis to support the organization. Additional roles include producing and managing the delivery of activity, value analytics and critical deliverables to external stakeholders and clients. This is a telecommute position with some ( 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:** + Provide direction, guidance and recommendations supporting decision making for large Medicaid data warehouse implementation and operations + With the specialized knowledge of the Medicaid and Children's Health Insurance Programs (CHIP), lead and guide internal and external stakeholders to make determinations relating to complex processes involving claims processing/adjudication, recipient eligibility, provider enrollment, and third-party liability + Proactively identify and understand state Medicaid agency data needs and determines the recommended solution to meet them with credible reason, justification and validated proof of concepts + Direct technical and business teams on healthcare topics understanding and utilizing healthcare data appropriately + Proactively suggest and recommend enhancements and improvements throughout the project processes, driven by Medicaid best practices, standards and policies 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 experience in information technology with 5+ years of experience working directly with/for State Medicaid agencies or equivalent supporting business initiatives through data analysis, writing business requirements and testing/validation of various systems + 2+ years of experience working CMS Federal Reporting MARS, PERM, T-MSIS, Quality of Care CMS Core Measure or similar projects + Knowledge of the Centers for Medicare and Medicaid Services reporting requirements and the programs covered + Understanding of claims, recipient/eligibility, and provider/enrollment data processes + Proven ability to create and perform data analysis using SQL, Excel against data warehouses utilizing large datasets + Proven excellent verbal/written communication and presentation skills, manager/executive/director-level client facing, team collaboration, and mentoring skills + Proven solid culture fit, demonstrating our culture values in action (Integrity, Compassion, Inclusion, Relationships, Innovation, and Performance) + Ability to travel to Springfield, IL two (3) to three (4) times per year or as needed **Note:** Core customer business hours to conduct work is M-F 8 AM - 5 PM CST. **Preferred Qualifications:** + 2+ years of experience in HEDIS, CHIPRA or similar quality metrics + Experience with data analysis using Teradata Database Management System or other equivalent database management system + Experience using JIRA, Rally, DevOps or equivalent + Experience in large implementation or DDI project + Located within driving distance (3 - 5 Hours) of Springfield, IL *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 $110,200 to $188,800 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._

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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together. This Director level is accountable for achieving assigned targets for Medicare Advantage providers in their assigned Market(s). The Director is responsible for developing and deploying business plans at the market level with a solid focus on managing CMS Risk Adjustment, Clinical Quality, HEDIS and Stars initiatives and building relationships across Market(s) to develop and optimize business opportunities and brand strength. Serving as the local Market expert, work with central function leads to target local strategies that will result in optimal Market(s) effectiveness. 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: * Ensure targets are met or exceeded for assigned Market(s) * Development and execution of clinical, RAF and quality strategy related HEDIS and Part D Stars Improvements in partnership with Medicare Market CEO, Executive Director, Data Support, and other Optum and UHC parties as appropriate * Regular reporting and updates to senior leadership, including Health Plan CEO, CMO, and market leads, this requires development of PowerPoint and Excel data packages * Leadership and support of achieving a minimum of 4 Star rating for assigned H contracts and for achieving 80% of our members in 4 Star or better plans * Solid focus on employee development and employee experience * Monitor Market level trends, risk and opportunities to continually evaluate ability to achieve established targets * Create provider targets for direct reports and assist in territory management penetration * Actively participate in the development and execution of site Coding Accuracy, HEDIS, (prospective and retrospective), Patient Experience and Stars strategic/business plans * Influence the development and improvement of operations/service processes * Drive the development and implementation of short-and-long range plans * Continually assess market competitiveness, opportunities, and risks * Drive initiatives to optimize Medicare Advantage payment and reimbursement strategy and capabilities * Build and maintain collaborative relationships with Corporate, Business units within UHG and other Medicare Advantage Plans, Provider relations/Network Development, Marketing and Sales, Clinical Operations, Senior Director leadership in each market * The Director will be accountable to ensure direct reports that oversee the field staff are performing at a high standard of performance * Be the primary go to person for all Risk/STARS related activities within their assigned market(s) working within a matrix relationship which includes Network, Market Leads, Health Plan Medical Directors, and other Health Plan and Optum team members to assure that all STARS activities are planned and executed * Weekly commitment of 50% travel for business meetings (including client/health plan partners and provider meetings) and 50% remote work 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: * 5+ years of experience in a high impact role as a leader in the managed health care industry * 5+ years of Medicare Stars experience and HEDIS experience * Experience in the development and execution of Coding Accuracy, HEDIS (prospective and retrospective), Patient Experience and Stars strategic/business plans * Experience developing and improving operations / service processes including short and long range plans * Demonstrated experience on driving initiatives to optimize Medicare Advantage payment and reimbursement strategy and capabilities * A broad base of experience across management care operations, extensive knowledge of health care industry, provider and insurance industry is required to be successful in this role * Weekly commitment of 50% travel for business meetings (including client/health plan partners and provider meetings) and 50% remote work Preferred Qualifications: * Reside in the upper Midwest (Missouri / Nebraska / Iowa / Illinois ) * 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 $110,200 to $188,800 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.

Explore opportunities with Lafayette Home Office, a part of LHC Group, a leading post-acute care partner for hospitals, physicians and families nationwide. As members of the Optum family of businesses, we are dedicated to helping people feel their best, including our team members who create meaningful connections with patients, their families, each other and the communities we serve. Find a home for your career here. Join us and embrace a culture of **Caring. Connecting. Growing together.** As the Revenue Cycle Analyst you will perform all revenue cycle reporting and analysis for revenue cycle leadership, operational teams, and accounting. This analysis consists of daily, weekly, monthly, ad ad-hoc reports using real-time data and information (financial, statistical and other data). The results of the analysis are then used to provide revenue cycle leadership and operations management (DVPs and other operations management) with real-time feedback. As the Revenue Cycle Analyst, you will have no direct report staff and solicits feedback from both Decision Support leadership and VP of Revenue Cycle. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Perform financial and reimbursement analysis to ensure accurate reimbursement and billing compliance + Conduct data mining to compile reports and provide healthcare analytics support for decision-making related to AR inventory reduction, denial management, and operational improvements + Compile and prepare data for use in forecasts, budgets, modeling, and analysis as requested + Compile statistical data for internal reports and regulatory agencies + Assist in creating a data warehouse with needed information (process started; work with IT to complete) + Collaborate with the revenue cycle team to regularly measure and improve business performance + Produce daily, weekly, and monthly revenue cycle reports in a timely, accurate, and consistent manner + Work with revenue cycle leadership to develop key performance indicators and improve reporting + Prepare variance analysis on under-performing agencies/PODs related to days unbilled, production issues, etc., and suggest operating improvements + Maintain excellent communication with supervisor, revenue cycle management personnel, and home office personnel + Actively participate in Monthly Operational Review meetings + Complete ad-hoc analysis projects as required (problem payer work, issue resolution, collection effectiveness measures, etc.). 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:** + Bachelor's Degree + 2+ years in a healthcare-related field + 2+ years in relevant Professional Accounting/Financial Analysis experience + Demonstrate superior analytical skills, both financial and statistical + Demonstrated a natural sense of urgency in all actions + Demonstrated ability to use modern accounting and financial software platforms and databases + Demonstrated solid proficiency in Microsoft Office applications. **Preferred Qualifications:** + Proven solid oral and written communication skills. + Excellent interpersonal skills + Ability to work alongside other management personnel to achieve high levels of operating performance. + Demonstrated ability to influence other personnel to produce improved operating outcomes. + Self-starter and self-motivated, able to consistently demonstrate these qualities in a fast-paced environment. *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 hourly pay for this role will range from $14.00 to $27.69 per hour 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 Escalations Advocate is an individual contributor role responsible for an exciting variety of responsibilities in Specialty Networks of OptumHealth. We are looking for someone with solid analytical skills, who can think critically. The perfect candidate is flexible, detail oriented, able to see the big picture, can work within and across multidisciplinary teams, build relationships and has a positive personality. We are seeking lifelong learners who stay up to date on regulations, industry trends and advancements in the field, in addition to constantly developing their personal skillset. Our team members are sought out as a valued experts by our case partners, accounts, and customers. *****Required schedule is Monday-Friday, 10:30am - 7:00pm CST***** You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. **Primary Responsibilities:** + Extensive work experience, possibly in multiple operational areas + Manage a challenging role in a fast - paced environment + Achieve timely resolution to urgent and non - urgent issues, most of our issues turn around in 48hrs + Synthesize and communicate complex information in understandable terms both verbally and written + Support issue resolution for a variety of internal and external customers + Critically analyze issues from multiple angles to determine the root cause and next steps + Analyze issues including conducting a root cause analysis by identifying potential compliance, process, or systemic breakdowns and communicate findings to management and issue resolution partners + Able communicate effectively with state agencies, regulators, external customers, clinical medical directors, and senior leadership + Utilize expertise to support issue resolution + Collaborate and coordinate across multiple teams, departments, and representatives + Recognize trends with escalated issues and identity, carry out or coordinate preventative action + Develop effective working relationships with the applicable internal and external customers + Ability to conduct quick and thorough in-depth research across many systems and platforms (Iset, Linx, Unet, Facets, etc.) + Work independently + Mentor and develop other team members + Hold others accountable for resolution activities + Review the work of others to assess accuracy with process requirements + Develop innovative approaches to issue resolution + Providing member advocacy including serving as a primary point of contact for members who require assistance with their healthcare needs + Reviewing and resolving complex claims issues, investigating claim discrepancies, and collaborating with the claims processing teams + Understanding medical and behavioral health terminology, treatment options, and guidelines 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:** + Behavioral Health Clinical licensure - independently clinically licensed (i.e., LPC, LCSW, LMFT, LMHC, etc.). + 5+ years of behavioral health care experience + 3+ years of customer service experience in the healthcare industry + Proven knowledge of or State and Federal regulations that govern commercial health insurance + Proficiency with computer and Windows PC applications + Proficiency with Linx, ICUE, OCM + Designated workspace and access to install secure high-speed internet via cable/DSL in home **Preferred Qualifications:** + Experience with or a willingness to learn behavioral health appeals/claims + Optum Care Advocacy or UM experience + Assessment and Triage experience *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 $58,800 to $105,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants. _At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission._ _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._

Bring your drive for excellence, teamwork, and customer commitment to Independence. Join us as we renew and reimagine the future of health care. Together, we will achieve our mission to enhance the health and well-being of the people and communities we serve. The Auditor, Payment Integrity role conducts pharmacy claim audits for Independence Blue Cross to ensure accurate provider payments, detect fraud, waste, or abuse, and improve audit processes. It requires a Certified Pharmacy Technician with at least four years of experience, including pharmacy and audit work, strong analytical skills, and proficiency in Microsoft Office and pharmacy claims systems. Conduct audits of claims submitted to Independence Blue Cross (IBX) to ensure accuracy of provider payments and charges. Analyze provider billing patterns to detect potential fraud, waste, or abuse. Perform audits through daily reviews, live audits, and desk audits to identify inappropriate billing practices. Review and verify provider billing records, collaborating with CFID audit analysts, auditors, investigators, internal, and external sectors Execute standard provider audit assignments using sound audit methodologies to uncover patterns of abuse or fraud. Screen and audit claim samples-both summary and detailed-to select cases for further review. Initiate and validate claim adjustments, maintain comprehensive audit documentation, and prepare statistical reports. Identify and escalate potential provider fraud or abuse to management. Contribute to the development and implementation of new audit processes and functions. Qualifications • Certified Pharmacy Technician (CPhT) required. • Minimum of four (4) years of relevant experience, including: • At least two (2) years in retail or hospital pharmacy. • At least two (2) years in pharmacy audit. • Extensive understanding of healthcare provider audit practices and medical terminology. • Familiarity with fraud, waste, and abuse detection methodologies. • Strong written and verbal communication skills for reporting and presenting audit findings • Proficiency in Microsoft Office applications, including Excel, Word, Outlook, SharePoint, and Access. • Advanced Excel skills (pivot tables, VLOOKUP, data analysis). • Experience with pharmacy claims systems such as RxTrack and RxClaim is preferred but not required. Fully Remote: This role is designated by Independence as fully remote. The incumbent will not be required to report to one of Independence's physical office locations to perform the work. However, the work must be performed in the Tri-State Area of Delaware, New Jersey, or Pennsylvania. IBX is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to their age, race, color, religion, sex, national origin, sexual orientation, protected veteran status, or disability. Must have an Android or iOS device that is compatible with the free Microsoft Authenticator app.