Senior Provider Relations Advocate - Remote within Rhode Island

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.The Senior Provider Relations Advocate serves as a subject matter expert and strategic liaison responsible for managing complex provider relationships and resolving high-impact claims, payment, authorization, access, data, and operational issues. This role partners closely with providers, internal business partners, payer organizations, and leadership to drive timely resolution, strengthen provider relationships, and continuously improve the provider experience. The successful candidate will demonstrate strong executive presence, sound judgment, and the ability to effectively navigate challenging or sensitive provider situations. This individual must be skilled at de-escalating concerns, communicating with confidence and credibility, and developing solutions in situations where established processes may not fully address the issue. Exceptional communication skills are essential, including the ability to present effectively to large audiences, facilitate difficult conversations, and develop and deliver provider education and training when needed. Working with minimal supervision, the Senior Provider Relations Advocate independently researches, analyzes, and resolves complex and often ambiguous issues requiring cross-functional coordination. The role is expected to maintain ownership from initial identification through resolution, identify root causes, drive accountability across business areas, appropriately escalate barriers and risks, and recommend sustainable solutions that reduce operational friction and improve provider outcomes. The ideal candidate will bring strong analytical, problem-solving, relationship-management, and influencing skills. Claims expertise is solidly preferred, as a significant component of the role involves researching and resolving escalated claims, payment, reimbursement, and related operational issues. If you are located in Rhode Island, you will have the flexibility to work remotely* as you take on some tough challenges. Primary Responsibilities:Serve as a senior point of contact for complex and high-impact provider and operational escalations, maintaining end-to-end accountability from intake through resolutionDevelop and sustain solid, collaborative relationships with providers and key healthcare stakeholders throughout Rhode Island, including physicians, hospitals, health systems, provider organizations, medical societies, hospital associations, and healthcare leadersEstablish meaningful face-to-face engagement with strategic providers and healthcare organizations to strengthen relationships, identify emerging concerns, and advance shared prioritiesBuild trusted, long-term provider relationships by effectively communicating organizational priorities, understanding provider perspectives, identifying areas of mutual interest, and supporting network stabilityCollaborate in the development and implementation of appropriate payment and reimbursement models with the provider communityProvide oversight of activities that support positive physician and hospital relationships, using a collaborative and data-driven approach to identify opportunities and measure progressPartner with network providers to identify and execute mutually beneficial initiatives that improve key administrative and operational performance measuresImplement provider engagement strategies designed to advance quality, efficiency of care, administrative performance, and the overall provider experienceServe as a visible and credible representative of the organization within the Rhode Island provider community and with strategic partnersFoster a culture of inclusion, respect, accountability, collaboration, and commitment to delivering exceptional value to providersDemonstrate a continuous-improvement mindset by identifying innovative approaches to resolving problems and improving how services are deliveredLeverage individual expertise and organizational resources to support the broader goal of improving the healthcare experienceAssess the severity, business impact, urgency, and appropriate course of action for complex provider issuesIndependently investigate and resolve escalated issues involving:Claims and payment discrepanciesPrior authorization concernsProvider and member data issuesEligibility concernsProvider incentive payment disputesAccess and technology-related issuesOperational and service-related concernsFacilitate timely resolution of provider issues through effective coordination and accountability across multiple business areasAnalyze claim adjudication outcomes, payment methodologies, remittance information, contractual considerations, and provider reimbursement concerns to determine appropriate resolution pathwaysPartner effectively with Claims Operations, Payment Integrity, Health Plans, Network Management, Contracting, Clinical Operations, Technology, and other stakeholders to resolve complex issuesEducate providers and internal business partners regarding claims processes, policies, operational requirements, and available resolution pathwaysConduct detailed investigations into complex provider and operational issues, separating isolated concerns from broader systemic opportunitiesAnalyze trends, recurring issues, and systemic barriers affecting provider satisfaction, administrative performance, and operational effectivenessIdentify root causes and recommend sustainable corrective actions rather than relying solely on short-term issue resolutionDevelop recommendations to improve processes, workflows, service delivery, and the provider experienceTranslate complex findings, data, and operational challenges into clear, actionable recommendations for business partners and leadershipServe as a trusted advocate for providers while appropriately balancing provider needs with contractual requirements, organizational policies, regulatory requirements, and business objectivesCommunicate complex or sensitive information clearly, professionally, diplomatically, and with a solutions-oriented approachBuild effective partnerships across Operations, Network Management, Claims, Payment Integrity, Contracting, Client Services, Quality, Clinical Operations, Technology, payer organizations, and other business areas necessary to resolve provider concernsInfluence outcomes across teams where direct authority may not exist by establishing clear accountability, maintaining effective communication, and driving issues toward resolutionIdentify and appropriately escalate systemic issues, emerging risks, operational barriers, and provider relationship concerns to leadershipProvide leadership with clear summaries of significant issues, business impact, root causes, recommended actions, and potential risks when escalation is required 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 equivalent5+ years of healthcare and/or managed care experience3+ years of provider relations and/or provider network management experienceExperience independently researching and resolving complex provider or operational issuesExperience presenting information to groups and facilitating professional discussionsDemonstrated experience managing challenging customer or provider interactions and effectively de-escalating concernsProficiency with Microsoft Word, Excel, PowerPoint, Access, and related business applicationsDemonstrated problem-solving, analytical, and critical-thinking skillsProven excellent written and verbal communication skills, with the ability to tailor communication to providers, business partners, and leadership audiencesDemonstrated ability to manage competing priorities and multiple complex issues in a fast-paced environmentDemonstrated ability to influence outcomes through collaboration, credibility, and relationship buildingDemonstrated ability to exercise sound judgment and make decisions in complex or ambiguous situationsMust reside in Rhode Island Preferred Qualifications:Claims processing, claims operations, and/or complex claims-resolution experienceExperience with provider reimbursement, payment integrity, claims adjudication, and/or prior authorization workflowsExperience managing complex or high-profile provider escalationsExperience working with physicians, hospitals, health systems, and senior healthcare leadersExperience conducting root cause analysis and implementing sustainable process improvementsExperience working across operational, clinical, financial, contracting, and technology teams to resolve complex issuesExperience developing or delivering provider education, presentations, or trainingKnowledge of healthcare provider operations and managed care environments *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 salary for this role will range from $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable. At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.  UnitedHealth Group and its affiliated brands are 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 and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.