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Senior Credentialing Representative

May 21, 2026

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. The Senior Credentialing Representative supports provider credentialing across multiple markets by managing end-to-end data entry, provider file preparation and system loading within MD Staff and related credentialing platforms. The position conducts audits, identifying process improvements and independently resolving complex issues. The role plays a critical part in ensuring accurate, compliant credentialing operations.Get ready for some significant challenge. This is a performance driven, fast paced environment where accuracy is key. You'll be helping us confirm to very exacting standards such as NCQA, CMS and state credentialing requirements.Schedule: Monday to Friday, 7 AM- 5 PM, 40 hours flexible time zoneLocation: Remote - NationwideYou will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities:<ul type="disc"><li class="MsoNormal" style="background-color:white;color:black;line-height:11.25pt;mso-list:l0 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Manage end-to-end provider enrollment workflows, including roster submissions, individual enrollments, and revalidations across multiple payers</li><li class="MsoNormal" style="background-color:white;color:black;line-height:11.25pt;mso-list:l0 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Maintain and update provider data across systems including MD-Staff, roster templates, and payer platforms, ensuring consistency and accuracy</li><li class="MsoNormal" style="background-color:white;color:black;line-height:11.25pt;mso-list:l0 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Proactively track and follow up on enrollment statuses, resolving delays and preventing gaps that impact billing or network participation</li><li class="MsoNormal" style="background-color:white;color:black;line-height:11.25pt;mso-list:l0 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Serve as a subject matter expert on payer-specific requirements, identifying nuances and adapting processes accordingly</li><li class="MsoNormal" style="background-color:white;color:black;line-height:11.25pt;mso-list:l0 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Partner closely with RCM to investigate and resolve claim denials, reimbursement delays, and enrollment-related billing issues</li><li class="MsoNormal" style="background-color:white;color:black;line-height:11.25pt;mso-list:l0 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Conduct audits, identify root causes of errors, and support process improvements to enhance accuracy and efficiency</li><li class="MsoNormal" style="background-color:white;color:black;line-height:11.25pt;mso-list:l0 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Manage high-volume workloads and competing priorities, ensuring deadlines are consistently met without sacrificing quality</li><li class="MsoNormal" style="background-color:white;color:black;line-height:11.25pt;mso-list:l0 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Operate effectively in an evolving environment where processes and job aids change; demonstrate the ability to bring structure and clarity</li><li class="MsoNormal" style="background-color:white;color:black;line-height:11.25pt;mso-list:l0 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Act as a go-to resource for complex work while supporting overall team performance and success</li><li class="MsoNormal" style="background-color:white;color:black;line-height:11.25pt;mso-list:l0 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Take ownership of issues from identification through resolution, including cross-functional coordination when needed</li><li class="MsoNormal" style="background-color:white;color:black;line-height:11.25pt;mso-list:l0 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Support process improvement efforts by contributing to projects and helping refine existing workflows and team processes</li><li class="MsoNormal" style="background-color:white;color:black;line-height:11.25pt;mso-list:l0 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Extensive work experience, often across multiple functions (Enrollment, Credentialing, RCM)</li><li class="MsoNormal" style="background-color:white;color:black;line-height:11.25pt;mso-list:l0 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Work frequently requires navigating ambiguity and developing new or improved procedures</li><li class="MsoNormal" style="background-color:white;color:black;line-height:11.25pt;mso-list:l0 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Works independently with a high degree of accountability</li><li class="MsoNormal" style="background-color:white;color:black;line-height:11.25pt;mso-list:l0 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Mentors others and acts as a subject matter expert</li><li class="MsoNormal" style="background-color:white;color:black;line-height:11.25pt;mso-list:l0 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Coordinates activities across teams and functions</li><li class="MsoNormal" style="background-color:white;color:black;line-height:11.25pt;mso-list:l0 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Drives process improvements and operational efficiency</li></ul>You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in. Required Qualifications:<ul type="disc"><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l0 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">High School Diploma/GED</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l0 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">4+ years of healthcare provider credentialing experience</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l0 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">2+ years of experience working with compliance workflows and processes, including NCQA policies and practices</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l0 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">2+ years of experience researching and applying payer and government regulatory requirements</li><li class="MsoNormal" style="background-color:white;color:black;line-height:normal;mso-list:l0 level1 lfo1;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;vertical-align:middle;">Intermediate level of proficiency with MS Excel and Word</li></ul>Preferred Qualifications:<ul type="disc"><li class="MsoNormal" style="line-height:normal;mso-list:l1 level1 lfo2;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;">MD Staff software experience</li><li class="MsoNormal" style="line-height:normal;mso-list:l1 level1 lfo2;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;">Proven ability to manage high-volume workloads, prioritize effectively, and meet tight deadlines</li><li class="MsoNormal" style="line-height:normal;mso-list:l1 level1 lfo2;mso-margin-bottom-alt:auto;mso-margin-top-alt:auto;tab-stops:list .5in;">Experience partnering with Revenue Cycle Management (RCM) or resolving enrollment-related billing issues</li></ul>*All Telecommuters 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 $20.38 to $36.44 per hour based on full-time employment. We comply with all minimum wage laws as applicable.<span class="eop" style="-webkit-tap-highlight-color:transparent;-webkit-text-stroke-width:0px;-webkit-user-drag:none;font-variant-caps:normal;font-variant-ligatures:normal;mso-color-alt:windowtext;orphans:2;text-decoration-color:initial;text-decoration-style:initial;text-decoration-thickness:initial;user-select:text;widows:2;word-spacing:0px;"> Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. 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. #RPO #GREEN

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...