Application Managed Services (AMS) - Rule Developer - Telecommute
UnitedHealth Group Work from Home/Remote Full-Time
Apply on company site
Job Details Company Overview
favorite_border
Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)
We have a position open for a Rules Developer to support the Optum Application Managed Services (AMS) Team. The AMS team engages in long term commitments and partnerships.
AMS provides full-service operation to our clients with a proactive approach to business communication, growth and problem resolution. The AMS team partners with health plan clients to become an extension of their organization. The highly seasoned staff is dedicated to managing Claims Edit System (CES) as well as looking at where CES fits in the client’s “Ecosystem”.  AMS provides services that will help provide long term benefit for the client, not only direct savings, and increased revenue but also savings in process, manual effort and other operational areas.
The Rule Developer role requires a highly flexible and adaptable skillset with the ability to handle periods of stress and/or heavy workloads. Solid experience as a Developer, rule writing, writing complex SQL/Oracle queries, or a similar role is required, preferably with demonstrated experience with healthcare claims or Medical /Drug/ reimbursement policies. The Rule Developer must have the ability to not only participate in meetings but also drive to effective solutions, while producing Rules based from detailed client requirements and other required supporting materials. This position requires the ability to communicate well between technical and non-technical personnel. The ability to adeptly navigate ever changing priorities is also a key skill of the Rule Developer. Additionally, the role requires each Rule Developer to become a Subject Matter Expert. The Rule Developer primarily works independently however is also expected to work collaboratively across teams and the organization to support our client's needs and meet their affordability and saving’s targets.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
• Participant in the ‘Rule Approval’ process
• Collaborate with Rules Business Analyst in evaluating business requirement and prepare detailed functional and technical specifications
• Design and develop simple to complex rules in Claims Edit System (CES)
• Conduct Unit Test of rules with the goal of zero defects before hand-off to the Integration Tester
• Prioritize and manage business requirements in an effort to minimize scope issues
• Define, document, and communicate system requirements, as related to CES and custom rule development.
• Diagnose root causes of rule / system defects/issues and collaborates with appropriate functional areas develop solutions
• Documentation of customer business processes, workflows, and requirements as they relate to issues identified by a development initiative.
• Review and contribute to overall QC/QA of test plans.
• Define, use and communicate design patterns and best practices in service-oriented analysis, design and development
• Collaborate with Integrated testing team to ensure testing efforts align with system deliveries and business processes
• Contributor to AMS Community: Ask an Expert, provides feedback for updated content - works with lead/owner of the committee
• Building out the rule library: feed information to client teams for updated information, etc.
• Communicate design to all stakeholders and varying levels of the organization
• Present and evaluate design solutions objectively and facilitate conflict resolution
• Identify opportunities to improve processes, customer engagement, and add client value to maintain and grow the business relationship
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:
• 3+ Experience with business/technical requirements and test case development
• 3+ Experience with healthcare claims or Medical /Drug/ billing and reimbursement policies
• 1+ years of experience interfacing at the Executive level
• 1+ year of user acceptance testing experience or equivalent knowledge
• Ability to bridge technical requirements and business needs to help drive solutions for our customers
• Experience in the delivery of complex technology solutions that address business issues within a large fast paced environment
• Proficiency with MS Office applications
Preferred Qualifications:
• Bachelor’s Degree
• Undergraduate degree
• Experience in Healthcare industry, either via direct work in the market (with insurers, hospitals, physicians, etc.) or via technology solutions being sold into the healthcare market
• Experience with CES, Claims Manager or Content Manager
• Experience or Proficiency with writing SQL or Oracle queries
• Coding experience or certified coder (AHIMA or CPC)
Soft Skills:
• Solid analytic, technical, and problem-solving skills.
• Excellent interpersonal, written, and verbal communication skills
• Ability to manage multiple priorities and execute deliverables on time
• Highly motivated and innovative, with the ability to work as part of a high-performance team as well as independently
• Demonstrates outstanding time management skills
• Demonstrated competency in large-scale organizations within a matrix environment
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $66,100 to $118,300. The salary range for Connecticut/Nevada residents is $72,800 to $129,900. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
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.
Recommended Skills
• Acceptance Testing
• Adaptability
• Analytical
• Billing
• Business Processes
• Business Requirements
Apply to this job.
Think you're the perfect candidate?
Apply on company site
Help us improve CareerBuilder by providing feedback about this job: Report this job
Job ID: 2109338
CareerBuilder TIP
For your privacy and protection , when applying to a job online, never give your social security number to a prospective employer, provide credit card or bank account information, or perform any sort of monetary transaction. Learn more.
By applying to a job using CareerBuilder you are agreeing to comply with and be subject to the CareerBuilder Terms and Conditions for use of our website. To use our website, you must agree with the Terms and Conditions and both meet and comply with their provisions.