Job Description
Independent Healthcare Consultant / Employee Benefits Advocate
Role Overview
The consultant will serve as an independent employee healthcare advocate, providing individualized and group-level guidance to help employees understand, navigate, and maximize their UnitedHealthcare (UHC) benefits.
Independence & Ethics
Must be independent of UnitedHealthcare and healthcare providers, disclose conflicts of interest, receive no carrier commissions, and adhere to strict confidentiality standards.
Core Services
UnitedHealthcare Cost Optimization & Benefit Maximization
Provide expert guidance on navigating UnitedHealthcare plan rules to maximize benefit utilization and cost recovery. This includes advising employees on strategic use of in-network versus out-of-network providers, understanding allowed amounts, balance billing risks, and the financial tradeoffs between provider choices. The consultant will assist employees in reviewing procedure coding and diagnosis information at a high level to help identify potential billing or claims issues, ensure services are billed consistently with covered benefits, and support successful claims adjudication. Guidance may include tips for pre-service cost estimates, prior authorization requirements, use of preventive care classifications, prescription formulary navigation, and best practices to minimize out-of-pocket costs.
ο§Benefits navigation and education
ο§ One-on-one employee advocacy
ο§ Claims and billing assistance
ο§ Cost optimization guidance
ο§ Preventive care and wellness navigation
Knowledge & Expertise
Deep familiarity with UHC plans, benefits approval tactics, and pharmacy benefits with some or all of the following certifications:
- CEBS (Certified Employee Benefit Specialist)
- Accredited Benefits Consultant
- Certified Health Advocate
Able to Conduct Employee Education
Group sessions, webinars, FAQs, and plain-language materials to help employees use benefits effectively.
Experience & Qualifications
Minimum 5+ years of healthcare advocacy or benefits consulting;
Engagement Model & Fees
Transparent fee structure (retainer, or hourly) β to be agreed before work starts.
Success Metrics
Improved employee understanding, reduced claims issues, increased preventive care usage, and positive employee feedback.
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Apply Now