The Senior Provider Relations Advocate serves as a subject matter expert responsible for managing complex provider, claims, payment, authorization, access, data, and operational escalations. This role acts as a liaison between providers, internal business partners, payer organizations, and leadership to ensure timely resolution of issues while improving the overall provider experience.
Working with minimal supervision, the Senior Provider Relations Advocate independently researches, analyzes, and resolves complex and often ambiguous issues that require cross-functional collaboration. This position plays a critical role in identifying root causes, driving accountability, escalating barriers, and recommending process improvements that reduce operational friction and improve resolution outcomes.
The ideal candidate possesses solid analytical, problem-solving, and relationship-management skills. A claims background is solidly preferred, as a significant portion of the role involves researching and resolving escalated claims, payment, and reimbursement issues.
The person hired into this role will need to be able to work Central Time Zone hours, generally 8am - 5pm, with some flexibility in schedule allowed.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:- Issue Escalation Management
- Manage end-to-end resolution of complex provider and operational escalations
- Assess issue severity, business impact, urgency, and required actions
- Investigate and resolve escalated issues involving:
- Claims and payment discrepancies
- Prior authorization concerns
- Provider and member data issues
- Eligibility concerns
- Provider incentive payment disputes
- Access and technology-related issues
- Operational and service-related concerns
- Facilitate timely resolution through effective coordination across multiple business areas
- Maintain ownership and accountability throughout the issue lifecycle from intake through closure
- Claims and Payment Resolution
- Research complex claims and payment inquiries utilizing multiple systems and data sources
- Analyze claim adjudication outcomes, payment methodologies, remittance information, and provider reimbursement concerns
- Identify root causes impacting claims processing and payment accuracy
- Partner with claims operations, payment integrity, health plans, network management, and other stakeholders to resolve issues
- Educate providers and internal partners on claims processes, policies, and resolution pathways
- Research and Root Cause Analysis
- Conduct detailed investigations into complex operational and provider issues
- Analyze trends, recurring problems, and systemic barriers affecting provider satisfaction and operational performance
- Identify opportunities for sustainable corrective actions
- Develop recommendations that improve processes, workflows, and customer experience
- Translate complex findings into actionable solutions for stakeholders and leadership
- Provider Advocacy and Relationship Management
- Serve as a trusted advocate for providers while balancing organizational policies and business objectives
- Assess and interpret provider needs and requirements
- Communicate complex information in a clear, professional, and customer-focused manner
- Build and maintain positive relationships with providers and internal stakeholders
- Cross-Functional Collaboration
- Partner with Operations, Network Management, Claims, Payment Integrity, Contracting, Client Services, Quality, Clinical Operations, Technology, and Payer organizations
- Escalate systemic issues and risks to leadership as appropriate
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
- 3+ years of experience in healthcare operations, provider relations, claims, network management, customer service, or related healthcare field
- Experience researching and resolving complex provider issues
- Facets claim system experience
- Microsoft Office, including Excel experience with pivot tables
- Demonstrated solid problem-solving, analytical, and critical thinking skills
- Demonstrated excellent verbal and written communication skills
- Demonstrated ability to manage multiple priorities in a fast-paced environment
- Demonstrated ability to influence outcomes through collaboration and relationship building
Preferred Qualifications:- Experience with provider reimbursement, payment integrity, claims adjudication, or prior authorization workflows
- Experience managing escalated provider issues
- Experience conducting root cause analysis and implementing process improvements
- Experience working with cross-functional operational and technology teams
- Claims processing, claims operations, or claims resolution experience
- Knowledge of healthcare provider operations and managed care environments
Knowledge, Skills, and Abilities- Advanced claims and payment analysis skills
- Knowledge of healthcare reimbursement methodologies and claims processes
- Solid investigation and research capabilities
- Root cause analysis and problem-resolution expertise
- Ability to work independently with minimal direction
- Solid organizational and prioritization skills
- Ability to effectively navigate ambiguous and complex situations
- Relationship management and conflict-resolution skills
- Proficiency with Microsoft Office applications and healthcare operational systems
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
