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What makes your Legal Risk Management career greater with UnitedHealth Group ? Growth opportunities with the potential to impact the health care system ensure it will always be challenging and exciting. Our Centennial, Colorado Legal Risk Management team is in need of a highly motivated Associate Legal Risk Manager with strong conflict resolution experience and project management experience. This individual will serve as a primary resource to senior management, plan sponsors, members across all states in resolution of oral and written complaints and member/provider disputes that create potential litigation risk for the organization. This position is responsible for advising the business on strategic and operational solutions to pre-litigation/high risk member/provider disputes for the Medicare and Medicaid insurance programs through influencing a wide variety of operational areas to implement resolution that mitigates any litigation exposure while ensuring the plan is fulfilling its contractual obligations to the membership.
Primary R esponsibilities:
- Research and resolve member/provider pre-litigation and Executive matters and complex or multi-issue disputes submitted by members/ providers to the government insurance programs.
- Provide expert knowledge and guidance to resolve complex issues while considering the regulatory rules that govern the insurance programs and complaints process. Up to and including negotiating pre-litigation settlements.
- Conduct root cause analysis by identifying potential compliance, process, or systemic breakdowns and communicate findings to management.
- Collaborate with internal departments to recommend and coordinate solutions to pre-litigation member/provider disputes, appeals and grievances.
- Manage the data integrity and reporting process for the department which includes analysis of the data to identify and report on systemic operational issues.
- Develop effective working relationships with the applicable regulatory agencies, plan personnel, team members, and senior leadership.
- Assist the business in preparing written responses to high risk member/provider disputes.
- Outreach to complainants to discuss resolution.
- High School Diploma / GED (or higher)
- 5+ years related experience
- 3+ years of experience working conflict resolution and persuasion skills
- Project management experience or equivalent experience working a high case load with competing priorities
- 5 years' experience serving as a Subject Matter Expert interfacing with business leadership
- 3+ years' experience working with cross-functional teams influencing/negotiating resolutions
- Proficiency with Microsoft Word - creating documents and navigation and Microsoft Excel - creating spreadsheet, data entry and navigation.
- 5 years' experience in the government insurance programs (Medicare and Medicaid) Medicaid preferred
- Bachelors Degree (or higher)
- Medicare Experience
- Excellent technical and professional writing and editing skills
- Strong verbal and written communication skills and presentation skills
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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