Claims Operations Manager - National Remote
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Working in Operations at UnitedHealth Group is 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
The Claims Operations Manager Role supports the Dental VACCN Contract along with processing functions, providing expertise or general claims support, conducts research to resolve claims issues and collaborates with our claims business partners to identify trends along with implementing solutions.
This position is full-time (40 hours/week) Monday - Friday. 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 CST). 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.
- Research, identify and obtain data/information needed to help process claims or resolve claims issues (e.g., verify pricing, prior authorizations, applicable benefits)
- Identify and resolve claims processing errors/issues and trends, as needed (e.g., related to system configuration, network, eligibility, data accuracy, vendor-related, provider)
- Resolve or address new or unusual claims errors/issues as they arise, applying appropriate knowledge or prior experience
- Collaborate with internal business partners to resolve claims errors/issues (e.g., Subject Matter Experts, Network Management, IT/systems staff, Compliance, legal, vendor management teams, contract teams)
- Document and communicate status of claims/investigations to stakeholders as needed, adhering to reporting requirements
- Use appropriate documentation, reference materials and/or websites to ensure that claims are processed accurately and efficiently (e.g., policy/procedure manuals, knowledge libraries, bulletins, training materials, databases, SharePoint sites, data warehouses)
- Learn and use new systems/applications/resources as needed
- Apply knowledge of applicable laws, regulations and compliance requirements to ensure that claims are processed properly
- Direct Report – 2; Indirect team of 30+
- Identify/develop/implement new claims processes procedures/solutions as needed, and document appropriately for future use (e.g., non-standard situations, special handling
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.
- High School Diploma / GED (or higher)
- 5+ years claims processing experience
- 2+ years of supervisory experience
- CMS Claim and Policy Knowledge
- Microsoft Excel skills at a minimum of intermediate
- Ability to trave up to 25%
- Ability to work an 8 hour shift between 8:00am – 5:00pm CST including the flexibility to work occasional overtime per business need
- Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation.
- Bachelor’s Degree (or higher) OR equivalent years of experience
- MedNet Claims Platform Knowledge
- Prior expertise with VA
- Knowledge of Medical and Dental Claim Processing
- Required to have a dedicated work area established that is separated from other living areas and provides information privacy
- Ability to keep all company sensitive documents secure (if applicable)
- Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
- Ability to communicate effectively, understand information, and speak clearly and professionally
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 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 has to 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.SM
Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $82,100 - $146,900. The salary range for Connecticut / Nevada residents is $90,500 - $161,600. 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.