Independent Healthcare Benefits Consultant/Patient Advocate for UHC Plans

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. Benefits navigation and education  One-on-one employee advocacy  Claims and billing assistance  Cost optimization guidance  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) – to be agreed before work starts. Success Metrics Improved employee understanding, reduced claims issues, increased preventive care usage, and positive employee feedback. Apply tot his job Apply To this Job