Sr. Coding Consultant, IFP Benefit Interpretation and Implementation - Remote

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

The Individual & Family Plans (IFP) business is a dynamic and expanding segment within UnitedHealthcare. The Senior Coding Consultant will report to the Director of Product Operations and plays a critical role in ensuring accurate interpretation and implementation by providing expert medical coding guidance. This role is responsible for interpreting and analyzing IFP regulatory and industry guidance-including Affordable Care Act (ACA) requirements, Essential Health Benefits (EHB), Benchmark Plan guidance, CMS regulations, CPT/AMA guidelines, major payer policies and internal business rules to support benefit administration through clear, well-documented recommendations.

The ideal candidate demonstrates knowledge of regulatory and coding principles across facility, professional, and specialty services (e.g., hearing, vision, dental), and the ability to translate complex coding standards into actionable insights for product development and operational execution.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Serve as the IFP coding subject matter expert, providing guidance on CPT, HCPCS, ICD-10, CDT and revenue codes to support benefit interpretation and administration
• Develop and maintain code sets used to define IFP medical and specialty benefits and limits, ensuring alignment with enterprise standards, regulatory requirements and market practices
• Monitor and manage implementation related to federal and state preventive benefit mandates for Individual & Family Plans (IFP), including the federal Patient Protection and Affordable Care Act (PPACA) and IRS Safe Harbor rules for HSA-eligible plans, ensuring accurate application across states and plans
• Lead or support enterprise initiatives related to benefit and code categorization
• Collaborate with cross-functional teams-including Clinical, Operations, Claims, and Configuration-to ensure benefit intent is accurately implemented and enhances member experience
• Partner with the Benefit Policy team to apply an IFP-specific lens to mandates and coding strategies
• Track and assess coding updates, identifying impacts to IFP documentation and ensuring timely revisions
• Respond to benefit inquiries by interpreting coding guidelines and internal policies
• Identify opportunities to improve outcomes and reduce costs through coding and benefit optimization

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:

• Active coding certification (CPC, CCS-P, CCS, CPMA, or equivalent) required and maintained in good standing
• 5+ years of medical coding experience in health insurance product implementation, benefit/coverage policy development, benefit configuration, or claims role
• Experience leading cross-functional initiatives, influencing stakeholders, and driving consensus across Clinical, Product, Operations, and Legal teams
• Demonstrated expertise in interpreting and applying federal and state mandates, coverage policies, reimbursement guidelines, and coding standards
• Deep knowledge of Commercial medical insurance benefits, including benefit design, configuration, and regulatory compliance
• Proven ability to mentor and guide junior staff, serve as a subject matter expert, and contribute to the development of best practices and training materials
• Proven ability to manage multiple priorities and deliver high-quality work in a fast-paced, matrixed environment

Preferred Qualifications:

• Experience with benefit configuration platforms and claims/editing systems, including the ability to translate benefit intent into system requirements
• Experience with health insurance reimbursement policy
• Proficient in Microsoft Word, Excel, PowerPoint, etc.
• Demonstrated accurate and precise attention to detail
• Demonstrated excellent analytical, verbal and written communication skills
• Demonstrated ability to work collaboratively and influence others to drive timely decisions
• Demonstrated ability to work independently, or as an active member of a team

*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 $110,200 to $188,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.