Claims Business Process Consultant - Remote in MN

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.

This position is full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am - 7:00pm local time (any time zone). It may be necessary, given the business need, to work occasional overtime.

We offer weeks of on-the-job training. The hours during training will be 7:00am - 7:00pm local time.Training will be conducted virtually from your home.

If you are located in MN, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Work independently while meeting appropriate deadlines consistently
• Work with minimal guidance; seeks guidance on complex tasks
• Act as a resource for others– primarily within the department, but also representing Behavioral Health Claim Operations across the enterprise
• Outbound calls to providers
• Coordinate own activities, work is self-directed and not prescribed
• Plan, prioritize, organize, and complete work to meet established objectives
• Identify and resolve claim basic operational problems using defined processes, expertise, and judgment
• Investigate claim issues as identified and communicate resolution to internal customers
• Identify root cause of issues
• Development and documentation processes for accurate and efficient claim payment
• Anticipate customer needs and proactively identifies solutions
• Call upon others for assistance outside scope and with large, complex issues
• Refer misdirected issues to non-claim teams
• Provide expertise and customer service support to internal customers
• Communicate research findings to applicable stakeholders
• Review assigned CPEWS, Adjustment Trends, Denial Trends alerts in an accurate and timely manner and acting as appropriate
• Apply knowledge / skills to identify and remediate straightforward claim issues
• Other duties as assigned

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