Director, Payment Integrity Non-Clinical Solution Operations - Hybrid
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. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life’s best work.
About the Role:
Non-Clinical Operations Payment Integrity within Optum Payer Operations is responsible for driving the development and execution of medical cost savings growth for UnitedHealthcare and Commercial client health plans by ensuring payment accuracy to support the enterprise objectives. The Non-Clinical Operations business drives significant medical costs savings from claims received by health care providers through all lines of business / Health plans in parallel to other operations within Payer Payment Integrity, technology, analytic & enablement teams.
This opportunity is based in Ireland. The successful candidate will be responsible for leading solution paths to support process improvements and transformation change with a specific focus to improve claims audit outcomes within our Operations that serve the United Healthcare business, and partnering with R&D / analytics, audit operations, automation/digital teams with existing or future solutions (including new technology platforms) resulting in higher yields on claims defects.
This is a key management position within a high value, fast paced and growing function within the Non -Clinical Operations and will work with technology partners and other enablement teams to progress a clear strategic technology vision with a high level of operational effectiveness. The successful candidate is to provide leadership specifically focused on technology and future state operations infrastructure and lead the value stream technical SMEs to progress technological milestones such as new workflow solutions, system migrations, and other technical developments to achieve a positive IOI outcome for the nonclinical member and claim products.
- Lead Non-Clinical Operations technology, support systems strategy and progress delivery of future state Target Operating Model
- Lead the portfolio of operational technology initiatives to achieve value stream revenue and productivity targets, including the realization of medical cost savings growth and operating cost efficiency
- Develop and agree operational requirements, resources and ‘business requirement documents’ in partnership with finance, workforce management / industrial engineering as part of the Capital and O&M roadmap
- Lead the management of change for enterprise solutions across the non-clinical value streams to include material system migrations such as a) member centric value streams e.g., Artemis for Coordination of Benefits, b) contract / claim centric value streams to the Comprehensive Audit Platform, Claim Audit Platform, post pay recoveries and c) transition of advanced analytics within the common U2 environment
- Provide a high level of assurance with testing, etc for operational readiness to ensure legacy data, analytics and technology assets are aligned to realize all planned benefits
- Lead and directly support operations technical subject matter experts across the non-clinical value streams
- Partner with Operations leadership, Analytics, Research & Development, Technology and Quality teams to ensure solution initiatives and strategies are implemented effectively
- Work across the teams and with business partners to identify additional affordability opportunities and delivery on organization / teams MBO’s
- Experienced in leading large-scale technology and application change within a matrix environment with a focus on operational solutions and benefit realization
- Proven track record in delivering high value productivity improvement results within a business using technology as the key lever
- Project Management and/or Scrum certifications
- Experience in managing data systems
- Extensive experience working with the ideation, development, and deployment of initiatives
- Operations and process management experience in a large-scale organization
- Previous experience working in a highly matrixed organization
- Strong conceptual and analytical skills
- Knowledge of US Healthcare industry, major healthcare entities and claims lifecycle
- Green Belt Six Sigma certified with in-depth understanding of LEAN process
- Consultancy and/or Business Process management experience with focus on End-to-End process improvement strategies
- Proficiency at a senior management level within a multi-national enterprise with experience of leading 100+ professionals though a technology change cycle
Careers with Optum. Here’s the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So, when it comes to how we use the world’s large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care must go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life’s best work.℠
Please note you must currently be eligible to work and remain indefinitely without any restrictions in the country to which you are making an application. Proof will be required to support your application.
Diversity creates a healthier atmosphere: Optum is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to gender, civil status, family status, sexual orientation, disability, religion, age, race, and membership of the Traveller community, or any other characteristic protected by law. Optum is a drug-free workplace. © 2023 Optum Services (Ireland) Limited. All rights reserved.