Out of Network Dispute Resolution Analyst

This position is National Remote. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together. The Out of Network (OON) Dispute Resolution team is responsible for end-to-end resolution of regulated OON disputes and arbitrations across UHC commercial lines of business on multiple platforms. This team is expected to continue expanding due to requirements related to the No Surprises Act section of the federal Consolidated Appropriations Act. The Out of Network Dispute Resolution Analyst reviews, researches, investigates, and resolves regulated OON disputes. This role requires strong claims knowledge, regulatory awareness, sound judgment, and the ability to identify trends, root causes, and potential process or system defects that may contribute to dispute volumes. As a key member of the Regulatory Affairs unit, the Analyst collaborates with regulatory contacts, internal business partners, and external vendors regarding regulated negotiation and arbitration / IDR disputes. Work may include complex or multi-issue inquiries, rate verification, root cause analysis, documentation review, and timely resolution in alignment with established production, turnaround time, and quality expectations. This position is full time, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 6:00 am - 6:00 pm local time. It may be necessary, given the business need, to work occasional overtime. We offer 2 weeks of paid training. The hours during training will be 9:00 am - 5:30 pm EST, Monday - Friday. Training will be conducted virtually from your home.

Review, research, investigate, and resolve OON regulatory disputes using sound judgment and appropriate escalation when needed Apply claims, benefits, eligibility, reimbursement policy, and compliance knowledge when evaluating OON program reimbursement disputes Perform rate verification and case analysis in accordance with applicable state and federal regulatory requirements Follow established processes and procedures, including accurate dispute categorization and documentation standards Obtain and review required documentation and packet materials needed to complete case review Identify root causes, trends, and potential process or system defects that may impact dispute volume, quality, or turnaround time Engage OON vendors when appropriate and collaborate with internal or external partners to support resolution of complex cases Communicate clearly, professionally, and timely with regulatory agencies, internal business partners, external vendors, and other key contacts Maintain awareness of new and emerging policies, laws, and regulations that may impact OON dispute resolution work Prioritize and organize assigned work to meet established productivity, schedule adherence, turnaround time, and quality standards Provide exceptional service to internal, external, and regulatory contacts at all times Complete basic tasks independently and recognize when complex reviews require supervisor guidance or subject matter expert support Complete select work where procedures may not be fully established by using sound reasoning, available resources, and appropriate escalation 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.

High School Diploma / GED OR