Receive assigned provider inquiries and perform a code review on both professional and facility claims Make determinations on cases after a coding review is complete Review various edits on cases and complete audit of medical records received to ensure proper editing is applied Review medical charts electronically Abstract and code diagnosis and procedures from the medica

Engage members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medicati

Small Business Sales (1 100) Create and drive strategies for top specialty producing agencies and Brokers Collaborate with Sales Management and/or Health Plan leadership regarding pipeline, persistency, market objectives and develop competitive strategies with specific Brokers/General Agents Work collaboratively with AE/RAC/SAE to support sales, product and process educat

Compile and/or integrate information needed to complete reports and documents Prepare and/or format office documentation (e.g., letters; spreadsheets; reports) needed for various audiences (e.g.,clients; executives; internal business partners) Review prepared documents to ensure accuracy and quality, and revise as needed Post relevant documentation (e.g., meeting notes; P

Synthesize and forecast industry trends, customer needs, competitive threats, survey insights, member experience best practices and internal and competitive performance to design industry leading customer service and health plan improvement strategies Serve as a subject matter expert in CAHPS measure specifications, member pain points, survey strategy and business operati

Proficient in review of medical records and the ability to identify pertinent information on which to base appropriate clinical decisions. Document relevant chronology of case review and provide rational for determination Plan, prioritizes, organizes and completes work to meet established objectives. Excellent verbal and written communication skills with internal and exte

Own the service experience of customers at the field level by working with the assigned team and other matrix partners as required to ensure issues are resolved promptly and accurately meeting the customer's expectations Develop and maintain strong relationships with internal partners throughout UHG to manage the customer service experience Fully accountable for supportin

Serve as primary contact as it relates to all enrollment tasks for assigned book of business, which include multiple group customers; maintain satisfied customers by providing superior service and practice attention to detail in various responsibilities. Answer member, provider, and group customer phone calls; adhering to department expectations for answering calls and pr

Compiles financial statements for various Management and Labor customers in prescribed formats by collecting financial data from Peoplesoft General Ledger and other finance data repositories while ensuring accuracy and consistency Prepares standard daily and month end journal entries pertaining to revenues and expense, reclassification entries and month end reconciliation

Administration of Pension Benefits Collection of data from pension participants to determine eligibility and vesting schedule. Answer questions via telephone and email to convey information regarding the provisions of the pension plans. Create various types of members or employer correspondence including letters and emails. Collection and data entry of participant hours w

Partner with community providers of peer support to expand the network and ensure quality services are available for our members Educate by creating new curriculum specific to state need and facilitate community trainings Model the principles of recovery and provide member perspective to our CM, UM, Network, Product and Affordability partners Advocate for a recovery persp

Assess, plan, and implement care strategies that are individualized by patient and directed toward the most appropriate, lease restrictive level of care Identify and initiate referrals for social service programs, including financial, psychosocial, community and state supportive services Manage the care plan throughout the continuum of care as a single point of contact Co

Manage projects from inception to completion through QI science methodology documentation including Project charters, PDSA cycles, Key Driver Diagrams, GEMBAs, Run Charts and Paretos Complete data analysis for projects to determine progress and if SMART aims are achieved or root causes of performance Lead multidisciplinary teams to complete project tasks Recommend appropr

Solid understanding of both fully insured and self funded marketplace and pricing disciplines Establish and maintain "strong and appropriate" level relationships with customers and consultants; ensure UHG senior management has customer specific "board level" contacts Develop and monitor client financial performance including renewal planning, negotiation and profitability

Engage members face to face and/or telephonically to complete a comprehensive needs assessment, including assessment of medical, behavioral, functional, cultural, and socioeconomic needs Develop and implement person centered care plans to address needs including management of chronic health conditions, health promotion and wellness, social determinants of health, medicati