Triple-S jobs in Guaynabo, PR - 32 jobs

Provider Service Executive Guaynabo, PR ABOUT US At Grupo Triple S, we are committed to provide meaningful job experiences for Valuable People (Gente Valiosa). We encourage an environment of very high ethical standards, always excelling in service, collaboration among the company, agility to deliver timely, and embracing accountability for results. When you join Grupo Triple S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our purpose to enable healthier lives. We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses. Let's build healthier communities together, join now! ABOUT THE ROLE Manages the business relationship with participating, providers, and administrative staff. Provides a high level of customer service and identify trends, threads and opportunities within providers. Builds and nurtures strong business relationship with providers. Requires ability to learn and follow policies, procedures and standards of their area, department and other related departments. Performs planning efforts within the department, whether for operational situations from day to day or project assignments or to coordinate multiple resources within the department or division. Anticipates customer needs and act proactively to ensure their satisfaction. Responsible to influence recommendations or decisions through critical reviews. Maintain a direct relationship with providers through immediate and effective attention of needs presented by them. WHAT YOU'LL DO * Provide guidance to suppliers through visits where they distribute information on billing, claims processing, established policies and others. * Identify common and repetitive problems and implement corrective action and channel requests for information and\or claims from providers. * Offer seminars to providers and their staff and some other facilities like Clinical Labs, Chemotherapy facilities on the process of Claims, Billing, Electronic Health System, Coordination of Benefits and company policies. * Orient the providers about the circular letters and the changes that occur. * Document all provider intervention. * Monitor the contractual indicators by providers and development an individual action plan. * Communicate the results of provider claims denials before they occur. * Identify and report findings in writing to the management through established processes. * Obtain and examine all relevant information to assess validity of complaints and to determine possible causes. * Generate reports to providers related to reconciliation process as per their request. * Maintains liaison with other departments for issue completion. * Participate in special projects assigned by supervisor WHAT YOU'LL BRING Bachelor's Degree in Business Administration, Health Science or Marketing, with one (1) to three (3) years of experience, preferably. Or Associates Degree (60-64 college credits) in Business Administration, Health Science or Marketing with three (3) to five (5) years of experience, preferably. Or at least 5 years of this work experience in lieu of. CLOSING DATE: It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, gender, gender identity, real or perceived sexual orientation, civil status, social condition, political ideologies, age, physical or mental disability, veteran status or any other characteristic protected by law. Drug-free company. Equality Employment Opportunity/Affirmative Action for Minorities/Females/People with Disabilities/Veterans". Employer with E-Verify to verify the eligibility of employment of all the new employees. We encourage Females, Veterans and Disabled to Apply.

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. Positions in this function are responsible for the management and manipulation of mostly structured data, with a focus on building business intelligence tools, conducting analysis to distinguish patterns and recognize trends, performing normalization operations and assuring data quality. Roles in this function could partner with stakeholders to understand data requirements and develop tools and models such as segmentation, dashboards, data visualizations, decision aids and business case analysis to support the organization. Other roles involved could include producing and managing the delivery of activity and value analytics to external stakeholders and clients. Team members will typically use business intelligence, data visualization, query, analytic and statistical software to build solutions, perform analysis and interpret data. Positions in this function work on predominately descriptive and regression-based analytics and tend to leverage subject matter expert views in the design of their analytics and algorithms. Primary Responsibilities: * Ability to distil criteria for data analysis * Experience analyzing large data sets * Assesses and interprets customer needs and requirements * Use pertinent data and facts to ideate, identify and solve a range of problems within area of expertise * Ability to communicate the outcome of this research in a manner suitable for the intended audience * Examine, assess, and document business operations and procedures to ensure operational efficiency and excellence * Ability to build relationships to increase velocity of concept conversion to identifications * Assesses and interprets customer needs and requirements * Identifies solutions to non-standard requests and problems * Solves moderately complex problems and/or conducts moderately complex analyses * Translates concepts into practice * Provides explanations and information to others on difficult issues * Review top denial reasons for training opportunities, potential rebuttals back to the client, and query enhancements * Create action plan with summary and claim details to ensure that all reporting, training and priority recommendations are delivered to Operation Management * Ensure that training is completed and feedback is received * Ensure that all needed production queries are enhanced accordingly * Other duties may apply * ENGLISH PROFICIENCY ASSESSMENT WILL BE REQUIRED AFTER APPLICATION* You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * 3+ years of SQL programming with the ability to perform effective querying * 2+ years of health care experience working with healthcare claims data * Mid-level to advanced experience in Excel * Proven analytical skills with the ability to collect, organize, analyze, and disseminate significant amounts of information with attention to detail and accuracy * Proven solid written and verbal communication skills with the ability to explain complex data analysis results to non-technical stakeholders * Proven solid attention to detail with a focus on quality and accuracy * Demonstrated exemplary verbal and written communication skills in English * Ability to work 40 hours weekly from Monday to Friday during our regular business hours from 7am to 7pm (Overtime as business needs dictate) Preferred Qualification: * Experience with SQL Server Reporting Services and SQL Server Integration Services 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 role performs Clinical Procedure Coding research and outbound calling activities related to Data Mining programs. The successful candidate will review all types of medical claim payments from a research perspective in support of auditors and new outreach ideation. This role requires strong interpersonal skills combined with deep Clinical Procedure Coding, billing and claim platform knowledge to support outbound calling activities. These outbound calling activities relate to a varied and specialized set of unlikely billing scenarios. The successful candidate should have prior experience within the U.S. HealthCare industry with specific proficiency within reimbursement policy, provider contracts and clinical coding. Expertise with regard to navigating and understanding UHG core claims platforms (UNET, COSMOS, CSP, NICE etc.) is an advantage for this role. Prior experience within Payment Integrity, Network Management or Claims Operations is a distinct advantage. All the above is undertaken in collaboration with various matrix business partners. Primary Responsibilities: * Obtain all available data relevant to determine suitability and conduct Outreach call * Work with payers/providers to review claim information and identify issues related to payment accuracy * Design and implement appropriate outreach calling strategies specific to providers and outreach scenarios to determine advantageous call success rates * Assesses and interprets customer needs and requirements * Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance * Use pertinent data and facts to ideate, identify and solve a range of problems within area of expertise * Ability to communicate the outcome of this research in a manner suitable for the intended audience * Identify potential concepts for retrospective and prospective savings through individual ideation and from several perspectives such as correct billing, clinical procedure coding, network contracting, policy reimbursement, medical documentation requirements, industry and federal guidelines * Advise auditors on billing and coding guidelines to identify potential overpayment scenarios * Document and communicate outcomes of outreach reviews to applicable stakeholders * ENGLISH PROFICIENCY ASSESSMENT WILL BE REQUIRED AFTER APPLICATION* You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * 2+ years of health care outreach experience designing call strategies and conducting calls to providers * 2+ years of health care experience working with claims data and / or medical codes * 2+ years of experience researching medical claims information both internal and external * 1+ years of experience working with processing and reviewing medical claims platforms * Experience analyzing claims to determine trends / patterns * Experience reading and interpreting medical bills and records, provider contracts, fee schedules, and claim payment policies * Professional proficiency in both English and Spanish (bilingual) * Computer proficiency in Microsoft Office including Word (create documents), Excel (data entry) and Outlook (send email / calendar utilization) Preferred Qualification: * Experience with Pharmacy billing 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 role is equally challenging and rewarding. It requires fluency in computer navigation and toggling while you confidently and compassionately engage in dialogue with the caller. Be assured that our training will provide you with knowledge of the various products, plans and levels of benefits available to members and you'll soon find yourself creating positive experiences and earning the gratitude of callers on an hourly basis. **Primary Responsibilities:** + Provides customer service support to providers through live phone call or live chat, to give updates on their credentialing status or contracting status and validates state specific requirement + Focus on resolving issues on the first interaction, navigating through complex computer systems to identify the status of the issue and provide appropriate response to the provider + Deliver information and answer questions in a positive manner to facilitate solid relationships with providers and continue to establish rapport + Complete the documentation necessary to track provider issues and facilitate the reporting of overall trends + Complete outbound calls as needed to complete case resolutions + Other duties or projects may apply **_***ENGLISH PROFICIENCY ASSESSMENT WILL BE REQUIRED AFTER APPLICATION***_** 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:** + 1+ years of experience in a related environment (i.e. office, administrative, clerical, customer service, etc.) using phones and computers as the primary job tools + Proven knowledge of Microsoft and Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications + Ability to work (40 hours/week) Monday-Friday. Flexible to work any of our 8 hour shift schedules during our normal business hours of 8:00am to 7:00pm ATL. It may be necessary, given the business need to work holidays and overtime + English proficiency **Preferred Qualification:** + Health care experience _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 SOC Operator safeguards people, assets, and operations by monitoring, investigating, and coordinating responses to intrusion alarms, AI‑based camera alerts, access control events, and live surveillance feeds within 24/7 operational environment. This role requires continuous situational awareness, sound judgement under pressure, validates alerts to minimize false positives, and coordinates timely response per established standard operating procedures (SOPs). Primary Responsibilities: * Monitoring & Response * Actively monitor intrusion alarms, AI video analytics alerts, access control events, and live VMS feeds for critical facilities * Maintain site operational awareness (maps, floor plans, alarm zones, camera layouts) to quickly orient on events * Triage and validate alerts to determine root cause using with associated camera views, badge/access logs, and prior incident history * Dispatch on‑site security/guard force, facilities, or maintenance as appropriate; notify local law enforcement per escalation criteria and jurisdictional guidance * Stand up or join incident collaboration channels; capture incident timeline and actions * Escalate incidents appropriately based on severity, risk level, and established escalation protocols * Reporting & Documentation * Create accurate incident reports, alarm tickets, and shift logs aligned to SOP/SLAs * Maintain chain‑of‑custody for evidence and ensure records are retained per policy and regulatory requirements * Contribute to daily shift briefs, handoffs, and post‑incident after‑action reviews (AARs) * Support audits and metrics reporting (acknowledgment time, validation rate, dispatch time, resolution time) * Follow all confidentiality, privacy, and regulatory requirements (e.g., HIPAA/PHI handling, data protection standards) * Operational Readiness & Availability * Operate effectively in a 24/7 Security Operations Center environment, including nights, weekends, and holidays * Maintain a high level of alertness and professionalism during extended monitoring periods * Demonstrate flexibility and availability to support coverage needs during critical incidents, severe weather events, holidays, or other high-risk operational periods * Adhere to assigned schedules, shift rotations, and mandatory overtime requirements when operationally necessary * Professional Conduct and Compliance * Exercise sound judgment, discretion, and professionalism always when handling sensitive or confidential information * Follow ethical standards and corporate security policies without exception * Maintain a calm, composed approach during high-stress or high-impact incidents * Collaborate effectively with internal teams (Corporate Security, Facilities, IT, Executive Protection) and external partners as needed 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: * 1+ years of experience in a Security Operations Center, control room, emergency communications center, or 24/7 operational environment * Proficiency with intrusion alarm systems, VMS/CCTV, and AI‑driven video analytics platforms * Solid triage, critical thinking, and decision‑making skills under time pressure * Clear, professional verbal/written communication; excellent incident documentation discipline * Fluency in English and Spanish * Ability to work rotating shifts (nights/weekends/holidays) and remain effective for long monitoring periods * Demonstrated commitment to confidentiality and appropriate handling of sensitive information appropriately Preferred Qualifications: * Experience coordinating with Executive Protection, facilities, IT, and public safety partners * Experience supporting enterprise level or multi-site security operations * Exposure to performance metrics, SLAs, or compliance operational environments * Familiarity with access control systems, badge event review, and alarm/video integration workflows 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.

Senior Project Manager Guaynabo, PR ABOUT US At Triple S, we are committed to provide meaningful job experiences for Valuable People (Gente Valiosa). We encourage an environment of very high ethical standards, always excelling in service, collaboration among the company, agility to deliver timely, and embracing accountability for results. When you join Triple S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our purpose to enable healthier lives. We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses. Let's build healthier communities together, join now! ABOUT THE ROLE Responsible for overseeing large and complex projects/programs or multiple projects simultaneously. This role requires ensuring projects are delivered on time, within scope and budget, gathering and defining requirements based on information, undertaking analysis, and making recommendations that will be used by others on a hierarchical level. The role will coordinate with cross-functional teams, manage stakeholder relationships, make effective presentations, facilitate working sessions, and provide leadership and direction to the Associate Project Managers and Project Managers. WHAT YOU'LL DO * Responsible for the overall direction of a large projects and programs, initiate and develop comprehensive project plans, implementation, execution, control, and completion of projects. * Define detailed project requirements, processes and discovery analysis during project or program inception. * Manage large project and/or program budgets, ensuring cost control and financial performance. * Monitor large project and/or program progress reports and metrics and adjust plans as needed to ensure successful project delivery. * Identify potential risk and develop mitigation strategies and plan. * Ensure large project and/or program documents are completed, accurate and accessible. * Ensure project deliverables meet quality standards ensuring compliance with policies and regulatory requirements. * Communicate effectively with executive stakeholders' management to understand project requirements, ensuring alignment and managing expectations. * Create and conduct effective presentations and working sessions with stakeholders. * Resolve conflicts and negotiate consensus among stakeholders. * Provider leadership and guidance to project team members. * Coordinate multiple resources within/outside your area to support the goals of the project. * Mentor and support Associate Project Managers and Project Managers, promoting professional development. * Foster a collaborative and high-performance environment. WHAT YOU'LL BRING Bachelor's degree in business administration with a major in Management, Engineering, Computer Science, Human Resources, Finance, Marketing, or related area, with a minimum of seven (7) years of experience, preferably in the insurance and health industry. It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, sex, gender identity, real or perceived sexual orientation, civil status, social condition, political ideologies, age, physical or mental disability, veteran status or any other characteristic protected by law. Drug-free company. Equality Employment Opportunity/Affirmative Action for People with Disabilities/Veterans". Employer with E-Verify to verify the eligibility of employment of all the new employees. We encourage Veterans and Disabled to Apply

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.** As a **Pharmacy Technician** you will assist in various pharmacy activities under the supervision of a licensed pharmacist. Your responsibilities will include preparing, delivering, and restocking medications; performing order entry; procuring drugs; billing. You will carry out your job duties according to written procedures and guidelines based on pharmacy standards and regulatory requirements. You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + High school diploma or equivalent + Active applicable state Pharmacy Technician license in good standing + Recent work experience as a Pharmacy Technician, ideally in a hospital or outpatient setting + Proficiency with pharmacy software + Available to work Monday through Friday, 40 hours per week, during our business operating hours of 7:00am-8:00pm and weekends during our business operating hours of 7:00am-3:30pm **Preferred Qualification:** + PTCB/CPhT _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 Info Security Risk Auditor is responsible for supporting and enforcing information security policies, standards, and procedures to safeguard proprietary, personal, and privileged electronic data. This role works closely with user departments and cross-functional teams to implement robust security controls, drive compliance, and foster a culture of security awareness. **Primary Responsibilities:** + **Risk & Governance** + Align security policies and standards with IT infrastructure frameworks (ISO 27001, NIST, ITIL) + Lead policy exception and risk management, including logging, assessment, and mitigation + Conduct vendor tier assessments, clarify tiering logic, and ensure correct application of security reviews + Oversee remediation of critical/high vulnerabilities, verify aging data, and confirm with SLOs on unresolved exploits + Support overall application security governance + **Compliance & Certification** + Ensure compliance with regulatory requirements (ISO 27001, NYDFS, NIST) + Lead and support ISO 27001/ISMS program implementation and audits for assigned geographies/scope + Maintain and update compliance trackers, dashboards, and reporting frameworks + Perform audits to identify control gaps and implement corrective action plans + Monitor compliance with corrective actions and address non-compliance issues + Review and attest security attributes for applications, including MFA, orientation, data type, and access provisioning + **Incident Management & Investigation** + Facilitate and lead security incident investigations, including physical security, fire safety, access control, and environmental controls + Ensure proper logging and escalation of incidents + Coordinate with other teams for incident related activities + **Security Awareness & Training** + Drive security awareness campaigns, training, and infographics for employees and contractors + Track and report on training completion rates, phishing metrics, and awareness initiatives + Develop and communicate security content, including videos and best practices + **Stakeholder Engagement & Communication** + Communicate professionally with stakeholders and end users through multiple channels + Collaborate with business, and other concerned teams for regulatory reporting and audit support + Provide consulting and support for customer audits, contract reviews, and acquired entity compliance + **Physical Security & Site Compliance** + Conduct physical compliance walks, assess fire safety, access control, secure printing, and data privacy at sites ***** ENGLISH PROFICIENCY ASSESSMENT WILL BE REQUIRED AFTER APPLICATION ***** You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + 8+ years of information security experience + Experience with ISO27001 (ISMS), HITRUST CSF, NIST Cybersecurity Framework, SOC Type1/2 + Professional proficiency both with English and Spanish + Proven auditing skills and ability to manage risk assessments/projects independently + Proven excellent verbal and written communication skills + Proven solid presentation skills, especially the ability to explain technology to non-technical personnel + Demonstrated ability to work independently, meet deadlines, and maintain stakeholder confidence **Preferred Qualifications:** + Certifications: CISSP, CISA, ISO27001 Lead Implementer or Lead Auditor + Experience in physical security, compliance walks, and site-level assessments 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. _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._ _\#PRLinkedIn_

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 SOC Supervisor plays a pivotal leadership role within the Enterprise Security Operations Center (ESOC), overseeing a team of agents responsible for monitoring AI-generated alerts from Ambient.AI and intrusion alarm systems. This role ensures operational excellence, compliance with protocols, and timely incident response across enterprise facilities. Key Responsibilities: Team Leadership & Oversight * Supervise SOC agents monitoring Ambient.AI alerts and intrusion alarms across platforms such as Lenel and Milestone. * Ensure agents maintain situational awareness and adhere to escalation protocols. * Conduct regular performance evaluations and provide coaching to enhance agent effectiveness. * Manage shift schedules, staffing levels, and coverage to maintain 24/7 operational readiness. Operational Excellence * Review and validate incident reports, ensuring accuracy and completeness. * Monitor system health and alert volumes to identify trends, false positives, and operational gaps. * Coordinate with internal stakeholders and external emergency responders during critical incidents. * Lead daily briefings and debriefs to ensure continuity and knowledge transfer across shifts. Process Improvement & Compliance * Develop and refine SOPs for AI alert validation, intrusion alarm response, and incident documentation. * Collaborate with technology teams to optimize system integrations and reduce latency in alert response. * Ensure compliance with enterprise security standards and regulatory requirements. * Support audits and reporting related to alarm metrics, risk reduction, and operational performance. Strategic Support * Provide input on technology upgrades, staffing models, and budget planning. * Liaise with executive protection, travel risk, and weather monitoring teams to align cross-functional security efforts. * Contribute to strategic initiatives such as site stratification, alarm rationalization, and AI-driven threat detection. * ENGLISH PROFICIENCY ASSESSMENT WILL BE REQUIRED AFTER APPLICATION* You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications: * 3+ years of experience in a SOC or security operations leadership role * Solid knowledge of AI surveillance platforms (e.g., Ambient.AI), intrusion alarm systems, and video management tools * Proven ability to lead teams in high-pressure, mission-critical environments * Excellent communication, analytical, and incident management skills * Familiarity with enterprise risk intelligence tools and compliance frameworks * Availability to work rotational schedules within 24/7 operations, Monday through Sunday * Demonstrated verbal and written communication skills in English and Spanish 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 Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start **Caring. Connecting. Growing together.** As an Epic Security Engineer within the Identity Access Operations team, you will play a critical role in managing user access across both Epic applications and enterprise systems. You will oversee automated and manual provisioning processes, ensure compliance with organizational and regulatory requirements, and collaborate with technical, clinical, and operational stakeholders to maintain a secure and efficient access environment. Your responsibilities will include administering Epic Security structures such as templates, roles, security classes, and provider records, while also supporting enterprise identity operations. **Primary Responsibilities:** + Work with Optum Connect/OITPS Leaders to understand and define the Manual Access Provisioning objectives, commitments, roadmaps specific to each client as well as under managed services (shared teams) + Review and process access requests from users and departments. Validate the accuracy and completeness of request information + Ensure compliance with access control policies and procedures. Coordinate with relevant stakeholders to obtain necessary approvals + Manage access rights and privileges, including role-based access control (RBAC) and attribute-based access control (ABAC) + Review, validate, and process Epic access requests, ensuring accuracy and alignment with clinical, operational, and technical workflows + Create, modify, and retire Epic user access leveraging EMP, SER, ECL, LRP, and department-level configurations + Apply and maintain Epic user templates, roles, and security classes to ensure consistent Least Privilege access across the organization + Collaborate with Epic application teams to understand module-specific access requirements. + Conduct Epic access audits to identify unused entitlements, access drift, or misaligned permissions + Ensure compliance with internal access control policies and external regulations. Identify and address potential security risks related to access provisioning. Provide guidance and training to users and departments on access management best practices + Collaborate with IT teams, business units, and security departments to understand their access requirements + Build and maintain positive relationships with stakeholders. Provide timely and accurate information on access provisioning activities + Mentor a team of analysts, providing guidance, support. Assign tasks, monitor progress, and ensure deadlines are met. Foster a collaborative and productive work environment + Conduct in-depth data analysis to uncover insights and support decision-making. Utilize advanced analytical techniques and tools to extract meaningful information from large datasets *****ENGLISH PROFICIENCY ASSESSMENT WILL BE REQUIRED AFTER APPLICATION***** 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 IAM experience with hands-on Epic Security provisioning and administration + Proven solid understanding of IAM principles, especially in healthcare environments + Experience with Epic modules, security classes, roles, templates, SER/EMP management, and access troubleshooting + Experience with various identity and access management tools and systems + Proven excellent organizational and time management skills + Proven excellent problem-solving and analytical skills + Proven solid communication and interpersonal skills + Proficiency in data analysis tools and techniques (e.g., SQL, Python, R, Excel) + Fully Bilingual Spanish/English proficiency + Reside in Puerto Rico **Preferred Qualifications:** + Certifications in identity and access management or security + Experience with automated provisioning tools and workflows + Proven knowledge of industry standards and regulations related to access management (e.g., GDPR, HIPAA) _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 Broker Agent Service Analyst will play a key role in supporting Medicare & Retirement Sales Operations by analyzing and processing new and existing agent onboarding and maintenance requests for UHC. As a business support liaison (BSL) you will provide exceptional customer service to all internal staff and external customers. In this role you will become responsible for basic to intermediate processing related to new hires, in addition to developing expertise related licensing, bill payments, and access. **Primary Responsibilities:** + Process access requests, equipment administration, and new hire onboarding activities through standardized processes and systems + Coordinate financial tasks and reconciliation related to new hires, including reimbursements, expense reports, and processing vendor invoices + Production desk processing of licensing work, including routine projects and cleanup initiatives + Perform analysis of submitted material for completeness and accuracy, analyzing, credentials and documentation + Ensure cases adhere to all policies and procedures, in addition to federal and state laws and regulations + Acts as internal liaison and customer service resource for producers and sales leaders relative to licensing process, systems issues, and coordination efforts to achieve "ready to sell" status + Meets all department standards for quality and service level agreements + Identify risks or issues and assess/implement alternate solutions 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:** + HS Diploma or GED + 3+ months of experience in a production, help desk, or analyst role + Knowledge of insurance industry, compliance, licensing or claims experience + Above average proficiency with user administration, including system settings and hardware + Professional proficiency in both English and Spanish (bilingual) + Comfortable with Microsoft Word (creating and editing documents) Excel (general spreadsheet navigation) SharePoint (knowledge management) and Outlook (email and calendar) + Ability to work 40 hours / week during standard business operating hours Monday - Friday from 8:00am - 8:00pm AST. It may be necessary, given the business need, to work overtime or weekends **Preferred Qualifications:** + Associates or Bachelor's degree (or higher) + Financial acumen or accounting experience + Proven excellent written and verbal communication skills + Proven solid communication, and interpersonal skills; able to work with team members and all levels within the organization. + Proven solid analytical/problem solving skills _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. Positions in this function investigates Optum Waste and Error stopped claims by gathering information, researching state and federal guidelines, and following internal procedure to determine the viability of the claim for further review in a production environment. Primary Responsibilities: * Clinical Case Reviews -75% * Perform clinical review of professional (or facility) claims vs. medical records to determine if the claim is supported or unsupported * Maintain standards for productivity and accuracy. Standards are defined by the department * Provide clear and concise clinical logic to the providers when necessary * Examine, assess, and document business operations and procedures to ensure data integrity, data security and process optimization * Investigate, recover, and resolve all types of claims as well as recovery and resolution for health plans, commercial customers, and government entities * Investigate and pursue recoveries * Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance * Use pertinent data and facts to identify and solve a range of problems within area of expertise * Other internal customer correspondence and team needs - 15% * Attend and provide feedback during monthly meetings with assigned internal customer department * Provide continuous feedback on how to improve the department relationships with internal team members and departments * Continuing education - 10% * Keep up required Coding Certificate and/or Nursing Licensure * Complete compliance hours as required by the department * ENGLISH PROFICIENCY ASSESSMENT WILL BE REQUIRED AFTER APPLICATION* 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: * Registered Nurse (RN), Coding Certificate or Nursing Licensure, for example: * Puerto Rico Registered Nurse * Certified Professional Coder (CPC) + CPC A * Certified Inpatient Coder (CIC) * Certified Outpatient Auditor (COC) * Certified Professional Medical Auditor (CPMA) * Certified Coding Specialist (CCS) * Experience in a hospital/inpatient setting, surgical or clinic * Demonstrated proficiency with computers, including Microsoft Suite of products * Willing or able to work from Monday to Friday, 40 hours per week during our business operating hours of 8am - 7pm ATL * Professional proficiency in both English and Spanish (Please note that an English proficiency assessment will be required for this position) Preferred Qualifications: * Experience working with medical claims platforms * Medical record coding experience with experience in Evaluation and Management Services in the outpatient/office setting * Presentation or policy documentation experience * Knowledge of CMS and AMA coding rules specific to CPT, HCPCS * Knowledge of CMS Coverage, Federal and State Statues, Rules and Regulations * Knowledge of Medicaid/Medicare Reimbursement methodologies * Working knowledge of the healthcare insurance/managed care industry * Working knowledge of medical terminology and claim coding 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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. Medical coding academy trainer delivers an effective certification training to equip learners to successfully clear a medical coding certification examination offered through the American Academy of Professional Coders (AAPC) while also providing the knowledge and skills needed to work as a professional medical coder. Primary Responsibilities: * Create, develop, and deliver a medical coding academy training course for either Certified Professional Coder (CPC) and/or Certified Inpatient Coder (CIC) as per business requirement * Support team in terms of registration and scheduling of their examination * Accomplish training readiness and all logistics required to conduct the academy training (coding manuals, training rooms, etc.) * Prepare learning materials whenever required * Tracking assessment scores * Organize, coordinate, and communicate training programs for the business * Provide feedback on regular basis * Partner with leadership to provide coaching during training * Provide feedback to management on individual and group training results * Provide feedback to the instructional design team * Review and update training materials as needed * Ability to facilitate diverse groups of people * Flexible to travel depending on business requirement to conduct training from different sites * Other duties may apply * ENGLISH PROFICIENCY ASSESSMENT WILL BE REQUIRED AFTER APPLICATION* 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: * Certified Medical Coder with the following credentials: CPC, CIC, or CCS (CPC is mandate) * 1+ years of experience in outpatient or inpatient coding/auditing * 1+ years of experience in a clinical setting * Demonstrated working knowledge of computer functions and applications such as Microsoft Office (Outlook, Word, Excel) and Windows operating systems * Willing to work 40 hours per week. (May be required upon business needs to work weekends, holidays, and shifting schedules) * Ability to work from an office - trainers are required to be in the office when the new hires are in the office * Fluent in Spanish/English Preferred Qualification: * Training experience 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 SOC Operator safeguards people, assets, and operations by monitoring, investigating, and coordinating responses to intrusion alarms, AI‑based camera alerts, access control events, and live surveillance feeds within 24/7 operational environment. This role requires continuous situational awareness, sound judgement under pressure, validates alerts to minimize false positives, and coordinates timely response per established standard operating procedures (SOPs). **Primary Responsibilities:** + Monitoring & Response + Actively monitor intrusion alarms, AI video analytics alerts, access control events, and live VMS feeds for critical facilities + Maintain site operational awareness (maps, floor plans, alarm zones, camera layouts) to quickly orient on events + Triage and validate alerts to determine root cause using with associated camera views, badge/access logs, and prior incident history + Dispatch on‑site security/guard force, facilities, or maintenance as appropriate; notify local law enforcement per escalation criteria and jurisdictional guidance + Stand up or join incident collaboration channels; capture incident timeline and actions + Escalate incidents appropriately based on severity, risk level, and established escalation protocols + Reporting & Documentation + Create accurate incident reports, alarm tickets, and shift logs aligned to SOP/SLAs + Maintain chain‑of‑custody for evidence and ensure records are retained per policy and regulatory requirements + Contribute to daily shift briefs, handoffs, and post‑incident after‑action reviews (AARs) + Support audits and metrics reporting (acknowledgment time, validation rate, dispatch time, resolution time) + Follow all confidentiality, privacy, and regulatory requirements (e.g., HIPAA/PHI handling, data protection standards) + Operational Readiness & Availability + Operate effectively in a 24/7 Security Operations Center environment, including nights, weekends, and holidays + Maintain a high level of alertness and professionalism during extended monitoring periods + Demonstrate flexibility and availability to support coverage needs during critical incidents, severe weather events, holidays, or other high-risk operational periods + Adhere to assigned schedules, shift rotations, and mandatory overtime requirements when operationally necessary + Professional Conduct and Compliance + Exercise sound judgment, discretion, and professionalism always when handling sensitive or confidential information + Follow ethical standards and corporate security policies without exception + Maintain a calm, composed approach during high-stress or high-impact incidents + Collaborate effectively with internal teams (Corporate Security, Facilities, IT, Executive Protection) and external partners as needed 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:** + 1+ years of experience in a Security Operations Center, control room, emergency communications center, or 24/7 operational environment + Proficiency with intrusion alarm systems, VMS/CCTV, and AI‑driven video analytics platforms + Solid triage, critical thinking, and decision‑making skills under time pressure + Clear, professional verbal/written communication; excellent incident documentation discipline + Fluency in English and Spanish + Ability to work rotating shifts (nights/weekends/holidays) and remain effective for long monitoring periods + Demonstrated commitment to confidentiality and appropriate handling of sensitive information appropriately **Preferred Qualifications:** + Experience coordinating with Executive Protection, facilities, IT, and public safety partners + Experience supporting enterprise level or multi-site security operations + Exposure to performance metrics, SLAs, or compliance operational environments + Familiarity with access control systems, badge event review, and alarm/video integration workflows _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 role performs Clinical Procedure Coding research and outbound calling activities related to Data Mining programs. The successful candidate will review all types of medical claim payments from a research perspective in support of auditors and new outreach ideation. This role requires strong interpersonal skills combined with deep Clinical Procedure Coding, billing and claim platform knowledge to support outbound calling activities. These outbound calling activities relate to a varied and specialized set of unlikely billing scenarios. The successful candidate should have prior experience within the U.S. HealthCare industry with specific proficiency within reimbursement policy, provider contracts and clinical coding. Expertise with regard to navigating and understanding UHG core claims platforms (UNET, COSMOS, CSP, NICE etc.) is an advantage for this role. Prior experience within Payment Integrity, Network Management or Claims Operations is a distinct advantage. All the above is undertaken in collaboration with various matrix business partners. **Primary Responsibilities:** + Obtain all available data relevant to determine suitability and conduct Outreach call + Work with payers/providers to review claim information and identify issues related to payment accuracy + Design and implement appropriate outreach calling strategies specific to providers and outreach scenarios to determine advantageous call success rates + Assesses and interprets customer needs and requirements + Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance + Use pertinent data and facts to ideate, identify and solve a range of problems within area of expertise + Ability to communicate the outcome of this research in a manner suitable for the intended audience + Identify potential concepts for retrospective and prospective savings through individual ideation and from several perspectives such as correct billing, clinical procedure coding, network contracting, policy reimbursement, medical documentation requirements, industry and federal guidelines + Advise auditors on billing and coding guidelines to identify potential overpayment scenarios + Document and communicate outcomes of outreach reviews to applicable stakeholders *****ENGLISH PROFICIENCY ASSESSMENT WILL BE REQUIRED AFTER APPLICATION***** You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + 2+ years of health care outreach experience designing call strategies and conducting calls to providers + 2+ years of health care experience working with claims data and / or medical codes + 2+ years of experience researching medical claims information both internal and external + 1+ years of experience working with processing and reviewing medical claims platforms + Experience analyzing claims to determine trends / patterns + Experience reading and interpreting medical bills and records, provider contracts, fee schedules, and claim payment policies + Professional proficiency in both English and Spanish (bilingual) + Computer proficiency in Microsoft Office including Word (create documents), Excel (data entry) and Outlook (send email / calendar utilization) **Preferred Qualification:** + Experience with Pharmacy billing _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 star **t Caring. Connecting. Growing together.** The health care system is still evolving at a rapid pace. Technology is driving new advances in how patient care is delivered and how it's reimbursed. Now, UnitedHealth Group invites you to help us build a more accurate and precise approach to claims adjudication. As part of our Recovery and Resolutions team, you'll help understand and overcome errors in claims processing. You'll have all the tools and backing you need to help manage subrogation files, negotiate settlements and ensure adherence to compliance policies. When you are in the business of health care, you're in the business of people. At UnitedHealth Group we want every customer experience to be distinctly personal. The challenge is complex. When people call us for help, their focus is on getting the best care possible. We help them understand their benefits and their options. This part of their lives matters a lot to them and it matters just as much to us. Our customer service teams have a serious responsibility to make every contact informative, productive, positive, and memorable for what it says about how much we care. As Provider Inquiry Call Center Representative you will be accepting and directing all incoming phone calls according to policy and procedures and department productivity and quality standards. Resolves routine to moderately complex issues, refers appropriately to Team Lead and/or Supervisor as needed. **Primary Responsibilities:** + Ensures quality customer service for internal and external customers + Handles all incoming phone calls and identifies/assess customers' needs accurately and timely regarding potential third party liability + Solves problems systematically, using sound business judgment + Applies appropriate communication techniques when responding to customers + Recommends customer service strategies and related improvements/enhancements + Maintains timely, accurate documentation for all phone call interactions + Consistently meets established productivity, schedule adherence, and quality standards + Seeks involvement in continuous quality and process improvement initiatives when warranted *****ENGLISH PROFICIENCY ASSESSMENT WILL BE REQUIRED AFTER APPLICATION***** 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:** + 1+ years of call center experience + Experience in an office setting environment using the telephone and computer as the primary instruments to perform job duties + Fully Bilingual Spanish/English proficiency + Willing or ability to work 40 hours / week during standard business operating hours Monday - Friday from 8am - 9:30pm AST. (It may be necessary, given the business need, to work Holidays, weekends and occasional overtime) **Preferred Qualifications:** + Experience within the healthcare industry + Experience in claims + Proven knowledge of medical terminology + Proficiency with MS Office _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 **Specialized Hospital Pharmacy Assistant** supports the pharmacy department with a specialized focus on administrative tasks as requested by the Pharmacy Director. This role ensures accurate record-keeping, inventory, billing support, and compliance with hospital policies, regulatory requirements, and payer standards, among others. The assistant works under supervision of a licensed pharmacist and in collaboration with client staff as required. **Primary Responsibilities:** + Review and reconcile high-cost medication usage daily + Audit patient-specific information about medication administration and accurate charges in the hospital's electronic medical record (EMR) + Maintain logs and reports of high-cost medications for internal auditing and compliance + Serve as liaison between pharmacy, nursing and administrative department (Utilization and Billing) regarding the use of high-cost medications + Assist in the preparation of medication use reports for pharmacy, finance and administration departments + Collaborate with billing and finance staff to ensure proper calculations related to coding and charge capture for medications outside of standard per-diem coverage + Provide support to resolve discrepancies in medication billing records + Compile and submit documentation to support insurance claims and prior authorization requests, when necessary, as required by Utilization Department + Asist with procurement with medication and supplies in coordination with pharmacy buyer and supervisor + Monitor inventory levels regarding medication availability vs active patient on the medications + Asist in any other task related with the operation of the pharmacy as request by the supervisor You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + High school diploma or equivalent + Register Pharmacy Technician and eligible for state registration/licensure + 2+ years of experience in pharmacy setting + Solid attention to detail and organizational skills + Proficiency in EMR, pharmacy information systems, and billing software + Intermediate to advanced proficiency in excel, including pivot table knowledge + Ability to communicate effectively with pharmacists, nurses, physicians, and administrative staff + Knowledge of medical terminology, pharmacy practices, and billing processes **Preferred Qualifications:** + Completion of an accredited pharmacy technician program + Experience in a hospital pharmacy setting + Experience with billing, charge capture, or healthcare documentation **Work Conditions:** + Hospital inpatient setting with both clinical and office-based tasks + Requires extended periods of computer work and interaction with multiple hospital departments + May include rotating shifts, weekends, and holidays depending on departmental needs _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 Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together. As an Epic Security Engineer within the Identity Access Operations team, you will play a critical role in managing user access across both Epic applications and enterprise systems. You will oversee automated and manual provisioning processes, ensure compliance with organizational and regulatory requirements, and collaborate with technical, clinical, and operational stakeholders to maintain a secure and efficient access environment. Your responsibilities will include administering Epic Security structures such as templates, roles, security classes, and provider records, while also supporting enterprise identity operations. Primary Responsibilities: * Work with Optum Connect/OITPS Leaders to understand and define the Manual Access Provisioning objectives, commitments, roadmaps specific to each client as well as under managed services (shared teams) * Review and process access requests from users and departments. Validate the accuracy and completeness of request information * Ensure compliance with access control policies and procedures. Coordinate with relevant stakeholders to obtain necessary approvals * Manage access rights and privileges, including role-based access control (RBAC) and attribute-based access control (ABAC) * Review, validate, and process Epic access requests, ensuring accuracy and alignment with clinical, operational, and technical workflows * Create, modify, and retire Epic user access leveraging EMP, SER, ECL, LRP, and department-level configurations * Apply and maintain Epic user templates, roles, and security classes to ensure consistent Least Privilege access across the organization * Collaborate with Epic application teams to understand module-specific access requirements. * Conduct Epic access audits to identify unused entitlements, access drift, or misaligned permissions * Ensure compliance with internal access control policies and external regulations. Identify and address potential security risks related to access provisioning. Provide guidance and training to users and departments on access management best practices * Collaborate with IT teams, business units, and security departments to understand their access requirements * Build and maintain positive relationships with stakeholders. Provide timely and accurate information on access provisioning activities * Mentor a team of analysts, providing guidance, support. Assign tasks, monitor progress, and ensure deadlines are met. Foster a collaborative and productive work environment * Conduct in-depth data analysis to uncover insights and support decision-making. Utilize advanced analytical techniques and tools to extract meaningful information from large datasets * ENGLISH PROFICIENCY ASSESSMENT WILL BE REQUIRED AFTER APPLICATION* 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 IAM experience with hands-on Epic Security provisioning and administration * Proven solid understanding of IAM principles, especially in healthcare environments * Experience with Epic modules, security classes, roles, templates, SER/EMP management, and access troubleshooting * Experience with various identity and access management tools and systems * Proven excellent organizational and time management skills * Proven excellent problem-solving and analytical skills * Proven solid communication and interpersonal skills * Proficiency in data analysis tools and techniques (e.g., SQL, Python, R, Excel) * Fully Bilingual Spanish/English proficiency * Reside in Puerto Rico Preferred Qualifications: * Certifications in identity and access management or security * Experience with automated provisioning tools and workflows * Proven knowledge of industry standards and regulations related to access management (e.g., GDPR, HIPAA) 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.** Positions in this function are responsible for the management and manipulation of mostly structured data, with a focus on building business intelligence tools, conducting analysis to distinguish patterns and recognize trends, performing normalization operations and assuring data quality. Roles in this function could partner with stakeholders to understand data requirements and develop tools and models such as segmentation, dashboards, data visualizations, decision aids and business case analysis to support the organization. Other roles involved could include producing and managing the delivery of activity and value analytics to external stakeholders and clients. Team members will typically use business intelligence, data visualization, query, analytic and statistical software to build solutions, perform analysis and interpret data. Positions in this function work on predominately descriptive and regression-based analytics and tend to leverage subject matter expert views in the design of their analytics and algorithms. **Primary Responsibilities:** + Ability to distil criteria for data analysis + Experience analyzing large data sets + Assesses and interprets customer needs and requirements + Use pertinent data and facts to ideate, identify and solve a range of problems within area of expertise + Ability to communicate the outcome of this research in a manner suitable for the intended audience + Examine, assess, and document business operations and procedures to ensure operational efficiency and excellence + Ability to build relationships to increase velocity of concept conversion to identifications + Assesses and interprets customer needs and requirements + Identifies solutions to non-standard requests and problems + Solves moderately complex problems and/or conducts moderately complex analyses + Translates concepts into practice + Provides explanations and information to others on difficult issues + Review top denial reasons for training opportunities, potential rebuttals back to the client, and query enhancements + Create action plan with summary and claim details to ensure that all reporting, training and priority recommendations are delivered to Operation Management + Ensure that training is completed and feedback is received + Ensure that all needed production queries are enhanced accordingly + Other duties may apply ***** ENGLISH PROFICIENCY ASSESSMENT WILL BE REQUIRED AFTER APPLICATION***** You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. **Required Qualifications:** + 3+ years of SQL programming with the ability to perform effective querying + 2+ years of health care experience working with healthcare claims data + Mid-level to advanced experience in Excel + Proven analytical skills with the ability to collect, organize, analyze, and disseminate significant amounts of information with attention to detail and accuracy + Proven solid written and verbal communication skills with the ability to explain complex data analysis results to non-technical stakeholders + Proven solid attention to detail with a focus on quality and accuracy + Demonstrated exemplary verbal and written communication skills in English + Ability to work 40 hours weekly from Monday to Friday during our regular business hours from 7am to 7pm (Overtime as business needs dictate) **Preferred Qualification:** + Experience with SQL Server Reporting Services and SQL Server Integration Services _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._