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Job Information

UnitedHealth Group Member Eligibility Specialist - San Antonio, TX in San Antonio, Texas

Do you have compassion and a passion to help others? Transforming healthcare and millions of lives as a result starts with the values you embrace and the passion you bring to achieve your life’s best work.(sm)

The Systems Specialist is responsible for maintaining the system functionality of member eligibility within the IKA Member Module. This position reviews and audits member eligibility or revenue for accuracy and completeness. It may require customizing entries as necessary based on rules for appropriate contracted entity. Position also partners with internal and external customers to assist with resolving member eligibility or revenue issues.

Primary Responsibilities:

  • Performs initial review of data and root cause analysis of business/systems processes related to Wellmed Member eligibility or revenue discrepancies

  • Collaborates with management, compliance, and other departments to ensure accuracy of all member data and transactions for WellMed in a timely and effective manner

  • Ensures assigned payer system file updates and reconciliations are per formed promptly, to ensure optimal operational performance

  • Provides tier-one level of service and escalates identified issues to appropriate business unit owner and project team for support, guidance, and resolution

  • Serves as a resource to other internal departments on Member Eligibility or IKA Member Module

  • Maintains awareness of best practices/approaches related to quality, productivity, and compliance of current operational guidelines

  • Assists with providing input related to system specification modifications and changes in regulation for WellMed supported business to management

  • Identifies, researches, and resolves eligibility/revenue discrepancies related to assigned payer

  • Ensures Member Health Information and complaints are continuously maintained in a secure environment upon receipt and as the information is handled and processed

  • Performs all other related duties as assigned

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 or GED

  • 2+ years of Managed Care experience

  • Intermediate level of proficiency with MS Excel

  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications:

  • 4+ years of planning and testing experience

  • 3+ years of Managed Care experience

  • 2+ years of experience with EDI processing

  • Experience with MARx system

  • Excellent verbal and written communication skills

  • Exceptional ability to organize, prioritize and communicate effectively

Physical & Mental Requirements:

  • Ability to lift up to 10 pounds

  • Ability to push or pull heavy objects using up to 10 pounds of force

  • Ability to sit for extended periods of time

  • Ability to receive and comprehend instructions verbally and/or in writing

  • Ability to use logical reasoning for simple and complex problem solving

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 WellMed . Our focus is simple. We're innovators in preventative health care, striving to change the face of health care for seniors. We're impacting 550,000+ lives, primarily Medicare eligible seniors in Texas and Florida, through primary and multi-specialty clinics, and contracted medical management services. We've joined Optum, part of the UnitedHealth Group family of companies, and our mission is to help the sick become well and to help patients understand and control their health in a lifelong effort at wellness. Our providers and staff are selected for their dedication and focus on preventative, proactive care. For you, that means one incredible team and a singular opportunity to do your life's best work.(sm)

WellMed was founded in 1990 with a vision of being a physician-led company that could change the face of healthcare delivery for seniors. Through the WellMed Care Model, we specialize in helping our patients stay healthy by providing the care they need from doctors who care about them. We partner with multiple Medicare Advantage health plans in Texas and Florida and look forward to continuing growth.

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.

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

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