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.

Primary Responsibilities:

• 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.

Required Qualifications:

• High School Diploma / GED OR equivalent work experience
• Must be 18 years of age OR older
• 1+ years of working knowledge of UNET and NDB
• 1+ years of experience in claims processing, including accurate claim adjustments and creation, routing, review, and management of ORS items
• Managed care OR medical insurance experience
• Experience with analyzing claim processing through the full adjudication process
• Experience with utilizing multiple systems efficiently and accurately
• Ability to work any of our full time, 8-hour shift schedules during our normal business hours of 6:00 am - 6:00 pm local time from Monday - Friday, including the flexibility to work occasional overtime given the business need

Preferred Qualifications:

• Experience with supporting regulatory dispute, negotiation, arbitration, or IDR-related work
• Experience with identifying trends, root causes, quality risks, or process improvement opportunities
• Experience in partnering with external vendors, regulatory contacts, or cross-functional business teams
• Intermediate Microsoft Excel skills, including filtering, sorting, formulas, and report review

Telecommuting Requirements:

• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

Soft Skills:

• Strong written, verbal, interpersonal, and professional communication skills
• Strong independent thinking, critical thinking, and problem-solving skills
• Working knowledge of Microsoft Word, Microsoft Excel, Microsoft Outlook, and Microsoft SharePoint
• Ability to work effectively with key customers, peers, internal partners, and external contacts
• Ability to prioritize work, meet deadlines, and perform effectively under time constraints

*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 hourly pay for this role will range from $20 - $36 per hour 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.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.