Associate Director, Network Pricing & Claims Integrity
Unitedhealth Group
UnitedHealth Group is seeking an Associate Director for their Network Pricing team, focusing on Drug Pricing & Claims Integrity. The ideal candidate needs at least 7 years in pharmaceutical pricing or claims adjudication, with strong analytical and financial modeling skills. The role emphasizes compliance with Medicare and CMS regulations, overseeing pricing accuracy in adjudication. You will enjoy the flexibility to work remotely within the U.S. as you tackle various challenges to optimize health outcomes globally. #J-18808-Ljbffr UnitedHealth Group
$112.7k - $193.2k
...UnitedHealthcare company, is seeking an Associate Director - AI Transformation to lead... ...products focused on improving claim adjudication efficiency, payment integrity, and operational accuracy. The... ..., product, clinical, pricing, network, compliance, and payment integrity...NetworkClaimsMinimum wageFull timeContract workWork experience placementWork at officeLocal areaRemote work- ...The Business Analyst, Pricing and Underwriting , is responsible... ...complementary suite of clinically integrated services and technology... ...strategy. Analyze pharmacy claims, drug pricing, rebate models,... ...prescription utilization, retail networks, rebates, Specialty/Mail...NetworkClaimsFull timeTemporary workWork at officeRemote workWork from home
$20.36 - $25.24 per hour
...Temp Claims Administrator Starkey is a world leader in the manufacturing... ...coverages are compliant with pricing and contracts language... ...balances by interacting with network contracts, third party... ...patients, contracts, and other integral departments in the SHT organization...NetworkClaimsHourly payContract workTemporary workWorldwide$20.36 - $25.24 per hour
...hard‑working, detail‑oriented Claims Specialist who will support... ...coverages are compliant with pricing and contract language Review... ...balances by interacting with network contracts, third‑party administrators... ..., contracts, and other integral departments within the SHT...NetworkClaimsHourly payContract workTemporary work$60k - $70k
...exciting opportunity for a Associate Product Marketing Manager to... ...lifecycle, including updates on pricing changes and product... ...growing Employee Resource Group network. For more information, visit... ...that solve their customers' AV integration and technology challenges....NetworkTemporary workWork experience placementWork at officeLocal areaWorldwideLong distance$292.3k
...across UnitedHealthcare's broad, national network. Serving more than 1 million members... ...national professional societies, trade associations, and through speaking opportunities at... ...management, network optimization, and payment integrity Provides clinical guidance to business...NetworkMinimum wageWork experience placementWork at officeLocal areaRemote work$134.6k - $230.8k
...Growing together The Director - Automations & Efficiencies... ...projects designed to optimize claims processing, provider engagement... ...workflows, and payment integrity initiatives Collaborate with... ...COB/subrogation, and provider network management Experience leading...NetworkClaimsMinimum wageFull timeWork experience placementWork at officeLocal areaRemote work$150k - $257.2k
Senior Director, Self-Funded & Stop Loss Products Job Category : Sales... ...which contemplate pricing, marketing, promotion and placement... ...internal collaboration with network management and health services... ...experience Preferred Qualifications Claims platform migration Strategic...NetworkClaimsFull timeTemporary workWork experience placementWork at office3 days per week$110.2k - $188.8k
...scale. Join us to start Caring. Connecting. Growing together.The Associate Director, Actuarial is a key role within our OptumHealth National... ...REACH, MSSP/Medicare Shared Saving Programs)Analyze revenue/claim data from multiple sources and translate complex concepts in...ClaimsMinimum wageFull timeWork experience placementWork at officeLocal areaRemote work$112.7k - $193.2k
...better outcomes and smarter health care spending. As the Associate Director of Actuarial Services on the UHG Trend Analytics team... ...Associate Director in this role will work with detailed health care claims data to build and maintain actuarial models to support...ClaimsMinimum wageFull timeWork experience placementWork at officeLocal areaRemote work$159.3k - $273.2k
...Growing together. The Senior Director of Behavioral Health Care... ...Clinical Operations, Product, Network, Quality and Finance to align... ...focused on efficiency, clinical integrity, scalability, and user... ...Ensure interoperability with claims, case management, provider portals...NetworkClaimsMinimum wageFull timeWork experience placementLocal area- ...UnitedHealth Group is seeking a knowledgeable Manager for Provider Networks to lead and direct provider relationships across the West Coast. In this role, you will enhance healthcare delivery by ensuring strategic development and compliance of provider network operations...NetworkRemote work
$63.26k - $98.05k
...throughout the process. Evaluate current pricing processes and recommend changes that... ...programs. Process HPI requests, Canon CSMP claims, Konica Alliance backups, and Sharp MAP/... .... What We're Looking For An associate degree and two years of relevant experience...ClaimsContract workShift work$100k - $150k
...this, we live by our values of Integrity, Performance, Collaboration,... ...organization and building a network of mutual success. The result... ...underwriting rules, guidelines, pricing methodologies and account... ...Loss, Underwriters, PULSE and Claim Examiners, to meet required deadlines...NetworkClaimsWork at office$292.3k
...the National Accounts Medical Director (NA MD) serves as the senior... ...engagement away from retrospective claim reviews toward forward‑... ...impact. Connect medical policy, network, regulatory, and legal... ...ability to balance clinical integrity and business outcomes. Excellent...NetworkClaimsFull timeWork at officeLocal areaRemote workShift work$89.9k - $160.6k
...trends, and by soliciting input from a broad network of experts across Optum. This highly... ...opportunities for growth within our core payment integrity businesses and be responsible for savings... ...analytic Perform quality audits for claim overpayment results and monitoring...NetworkClaimsMinimum wageFull timeWork experience placementWork at officeLocal areaRemote work$65k - $90k
...attorneys manage a range of tools for a clients claim, from clients claims from demand letter,... ...across applications, endpoints, and network to determine root cause Provide hands... ...teams Application Administration & Integration Support administration and...NetworkClaimsWork at officeRemote workFlexible hours$115k - $145k
...Senior Analysts or Research Associates, depending on their prior... ...firm and help you get integrated. Additionally, we host continuous... ...works with an extensive network of prominent academics... ...of fair merger prices, securities litigation, claims in consumer finance, anticompetitive...NetworkClaimsFull timeWork experience placementLocal area$21.76 - $45.96 per hour
...invoicing, and ensuring the reconciliation of claims, credits, andpricing Resolve problems... ...in company systems, e.g., pack sizes, pricing, and commoditydescriptions Convey... ...Plus a broad range of career development, networking, and team-building opportunities...NetworkClaimsHourly payContract workTemporary workWorldwideFlexible hours- ...Description As part of our Retail team, the Associate Manager is responsible for creating a... ...as needed. Have a strong sense of integrity and an ability to lead by example. Have... ...of recycled materials, and global repair network. PARTNERS WE BELIEVE IN. Staying true to...NetworkFlexible hoursNight shiftWeekend workDay shift
- ...Business Analyst Claims Payment Integrity Remote Contract Domain & Data Expertise (Required) Familiarity with Call Center datasets (member... ...specific reporting, including: o Duplicate claim identification o Pricing anomalies o Eligibility issues & benefit mismatches...ClaimsContract workRemote work
$72.8k - $130k
...UnitedHealth Group in Eden Prairie, Minnesota, seeks a Network Manager to negotiate facility agreements and manage contract performance... ...management along with a deep understanding of Medicare and claims processing. Competitive salary ranges from $72,800 to $130,000,...NetworkClaimsContract workRemote work$160k - $180k
...Director, Integrations The Director of Integrations plays a critical role in partnering with the Head of Integrations to successfully execute... ...and operations teams Address custodial setup, pricing discrepancies, and account structure issues Process...Full timeTemporary workWork at officeLocal area$62.7k - $107.5k
...role will possess an understanding of pharmacy and medical claims, pharmacy drug pricing, pharma rebates, drug life-cycle, drug pipeline, and PBM... ...stakeholders including, clinical, financial, actuary, provider, network, and operations Required Qualifications Bachelor's...NetworkClaimsWork experience placementWork at office3 days per week$112.7k - $193.2k
...drive better outcomes and smarter health care spending. As an Associate Director of Actuarial Services on the UHG Trend Analytics team, you... ...Associate Director in this role will work with detailed health care claims data to support medical expense analytics and forecasting....ClaimsMinimum wageFull timeWork experience placementLocal area$120.1k - $214.5k
...conversations, operational signals, and network patterns into action. In this role, you... ...emerging fraud, waste, and abuse across claims, enrollment, provider, and encounter data... ...that use function calling, dynamic tool integration, and orchestration frameworks such as LangChain...NetworkClaimsMinimum wagePermanent employmentFull timeWork experience placementWork at officeLocal areaImmediate startRemote work$120.1k - $214.5k
...conversations, operational signals, and network patterns into action. In this role, you... ...emerging fraud, waste, and abuse across claims, enrollment, provider, and encounter data... ...that use function calling, dynamic tool integration, and orchestration frameworks such as LangChain...NetworkClaimsMinimum wagePermanent employmentFull timeWork experience placementWork at officeLocal areaImmediate startRemote work$130.3k - $223.4k
...every member feels valued. The Director of Benefits & Leaves of Absence... ..., innovation opportunities, pricing, and benchmarking Oversee analysis of claims data, utilization patterns, and... ...strategy, and plan changes Champion integration of wellbeing, financial wellness...ClaimsContract workWork experience placementWork at office3 days per week$112.7k - $193.2k
...and the payment models associated with these technologies.... ...report to the Clinical Director of Health Technology Innovation... ...Optimize process flows, claims edit changes, code... ..., IT, clinical, payment integrity, legal, regulatory, compliance, networks, and payment policy, among...NetworkClaimsRemote jobMinimum wageFull timeWork experience placementLocal area$91.7k - $163.7k
...ongoing maintenance, supporting integration, configuration, and migration... ...between technical and claims operations personnel. You'... ...to Clients specific tracking, network configuration, rules of engagement... ...3+ years of experience in pricing Medicare hospital facility claims...NetworkClaimsMinimum wageFull timeContract workTemporary workWork experience placementWork at officeLocal areaRemote work
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