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Job Details


UnitedHealth Group

Claims Manager - National Remote

Healthcare

Nurse Manager

Yearly

No

Dallas, Texas, United States

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

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.SM

You'll join a high caliber team where you're assisting, educating, problem-solving and resolving tenuous situations to the best possible outcomes. Bring your people skills, emotional strength, and attention to detail. Get ready to start doing your life's best work.SM

The Claims Operations Manager is responsible for staff management, administration of multiple functions and management of general business operations within the Claims Organization.


This position is full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm. It may be necessary, given the business need, to work occasional overtime.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

  • Oversee daily operations of multiple levels of staff and multiple functions across one or more business units.
  • Manage day to day site operations, leadership (internal and external to organization), and accountability for financial and non-financial results (budgets and actuals).
  • Provide oversight and authorization to ensure appropriate payment on claims occurs
  • Conduct analysis of quality trends and claim re-work; provides improvement plans as necessary.
  • Drive project management and implementation initiatives.
  • Positions in this function are responsible for performance guarantee attainment, contract compliance, regulations at the federal and state level, quality outcomes within established policies and procedures.
  • Responsible for all aspects of performance including coaching and development, career progression, employee engagement and effective communication.
  • Influences and provides input to forecasting and planning activities
  • Responsible to maintain existing policies, procedures and best practices of the program
  • Execute implementation changes in support of state and federal requirements
  • Effectively manage inventory to optimize the provider experience
  • Reduce denial rates
  • Develop state and product level auto adjudication plans with shared services to improve cost structure and accuracy
  • Ensure business controls are in place and are effective to minimize surprises
  • Understand membership and product mix with different complexities, contact rates, etc.
  • Understand adjustment drivers and reduce rework related to claim process
  • Understand appeals drivers and reduce appeals related to claim process
  • Engage in External Audits and CAP remediation
  • Ensure all reporting needed to effectively manage are in place and fully utilized

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:

  • High School Diploma / GED (or higher)
  • 3+ years Demonstrated leadership experience
  • 2+ years managing relationships with clients and/or vendors
  • 2+ years managing budgets, process improvement and quality assurance
  • 5+ years supervisory/managerial experience in claims adjudication or customer service
  • Ability to create and modify spreadsheets Microsoft Excel
  • Ability to create and modify documents within Microsoft Word

Preferred Qualifications:

  • Bachelor’s Degree (or higher)
  • 5+ years of healthcare claims leadership experience
  • Understanding of claims processing systems
  • Understanding of Medicare and Medicaid regulations

Telecommuting Requirements:

  • Ability to keep all company sensitive documents secure (if applicable)
  • Required to have a dedicated work area established that is separated from other living areas and provides information privacy
  • Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

UnitedHealth Group requires all new hires and employees to report their COVID-19 vaccination status.

Military & Veterans find your next mission: We know your background and experience is different and we like that. UnitedHealth Group values the skills, experience and dedication that serving in the military demands. In fact, many of the values defined in the service mirror what the UnitedHealth Group culture holds true: Integrity, Compassion, Relationships, Innovation and Performance. Whether you are looking to transition from active duty to a civilian career, or are an experienced veteran or spouse, we want to help guide your career journey. Learn more at https://uhg.hr/transitioning-military

Learn how Teresa, a Senior Quality Analyst, works with military veterans and ensures they receive the best benefits and experience possible. https://uhg.hr/vet

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 5 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near - obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, Military families, and Veterans wherever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life’s best work.SM

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $66,100 to $118,300. The salary range for Connecticut / Nevada residents is $72,800 to $129,900. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: #RPO, #YELLOW

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