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UnitedHealth Group Systems Specialist - San Antonio, TX in San Antonio, Texas

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

Required Qualifications:

  • High School diploma or GED

  • 3+ years experience working in an office environment

  • Intermediate proficiency in Excel (vlookups, pivot tables)

Preferred Qualifications:

  • 2+ years of Managed Care experience

  • 2+ years of experience with EDI processing

  • 4+ years of planning and testing experience

  • Experience with MARx system

  • Excellent verbal and written communication skills

  • Proficient computer literacy skills

  • Exceptional ability to organize, prioritize and communicate effectively

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 240,000+ 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)

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare’s support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.


Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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

Job Keywords: Systems Specialist, San Antonio, TX, Texas