Job details
Job type full-time
Full job description
Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you getLeading edge technology in an industry that`s improving the lives of millionsHere, innovation isn`t about another gadget, it`s about making health care data available wherever and whenever people need it, safely and reliablyThere`s no room for errorJoin us and start doing your life`s best work.(sm)
On the one hand, no industry is moving faster than health careOn the other, no organization is better positioned to lead health care forward than optum and unitedhealth groupThat’s what makes this opportunity so applause worthyWe have hundreds of business verticals across our matrixed organizations that are bringing thousands of new ideas, services, and products to the marketplace every yearOur goal is simpleUse data and technology to help drive change and make the health care system work better for everyoneWhen you join us as an associate director of claims, you`ll be engaged in a complex business model that is highly adaptable to build solutions that meet their customer needs in a competitive and effective way.
This role will challenge your ability to work in a complex environment of claim processing operations where we are expanding capabilities rapidly to meet customer requirements and grow the businessYou’ll need flexibility, agility, and the ability to adapt to change while maintaining strong relationships with stakeholders in a highly cross-matrixed environment.
You’ll enjoy the flexibility to telecommute* from anywhere within the u.sAs you take on some tough challenges.
Primary responsibilities:
Provide leadership to and is accountable for the claim operation performance and direction through multiple layers of management and senior level professional staff
Scope of responsibility across multiple regions/sites and markets
Lead claim processing operation:
Achieve market slas through operational discipline, implementing process controls and delivering end to end quality
Demonstrate knowledge of applicable claims processes (e.g., end-to-end claims cycle, auto-adjudication, manual work processes, payment methodologies, rework/adjustment processes)
Leverage forecasting systems/processes to identify applicable problems/issues/opportunities (e.g., inventory, inflow, overtime), and analyze historical data/trends to drive inventory inflow and resource planning
Identify and resolve claims processing errors/issues and trends, as needed (e.g., related to system configuration, network, eligibility, data accuracy, vendor-related, provider)Collaborate with internal business partners to resolve claims errors/issues (e.g., subject matter experts, network management, it/systems staff, compliance, vendor management teams, contract teams)
Support growth through scalable capabilities across technology, operations, health plan and market
Monitor effectiveness of business processes (e.g., quality, accuracy, turnaround time, key performance metrics) and/or business targets (e.g., financials, time to pay, performance guarantees)
Lead the claim operations implementation build for expanding business
Obtain and validate business requirements from applicable stakeholders (e.g., using health plan documentation, market and regional business objectives, provider network management, national regulatory lists, etc.)
Analyze business requirements to determine if existing systems/processes are optimized to achieve those goals, and to identify potential problems/issues/opportunities
Identify/analyze potential solutions to claims business processes problems/issues (e.g., process simplification, auto-adjudication, quality improvement, processing accuracy)
Partner with applicable stakeholders to drive effective implementation of solutions to meet implementation requirements (e.g., claims leadership, configuration, pdm, automation, quality, other business partners)
Identify and analyze claim operations problems/issues/opportunitiesDevelop/recommend and implement solutions to improve claims business processes
Identify root causes of identified claims processing problems/issues (e.g., root cause analysis, workflow analysis, vendor analysis)
Leverage applicable industry standards/benchmarks, and identify opportunities for improvement based on industry standards
Develop appropriate measurement approaches/metrics to evaluate the effectiveness of implemented solutions/process changes (e.g., quality, accuracy, turnaround time, key performance metrics) and/or business targets (e.g., financials, time to pay, performance guarantees)
Demonstrate knowledge of applicable laws and regulations
Demonstrate knowledge of applicable legal/compliance requirements, and the penalties associated with non-compliance (e.g., hipaa, cms, state regulations, performance guarantees, service level agreements)
Maintain awareness of changes to applicable laws and regulations impacting claims business processes (e.g., healthcare
Reform/ppaca, cms, state regulations)
Translate and incorporate changes to laws and regulations for use in applicable business process documents (e.g., process summaries, instructions, procedures)
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:
5+ years progressive leadership in claim operations
1+ years of client engagement experience
1+ years of vendor management experience
Demonstrated experience managing complex business operations/processes – driving efficiencies and scaling for growth, and implementing appropriate operational controls and metrics
Experience implementing business operations per client requirements to expand operations
Experience with trizetto facets claim adjudication platform
Preferred qualifications:
Experience with multiple products (medicare, medicaid, duals, commercial)
Experience working across multiple health plan payors
Unitedhealth group requires all new hires and employees to report their covid-19 vaccination status.
Careers with optumHere`s the ideaWe built an entire organization around one giant objective; make health care work better for everyoneSo 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 serveOptum, 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 potentialFor you, that means working on high performance teams against sophisticated challenges that matterOptum, incredible ideas in one incredible company and a singular opportunity to do your life`s best work.(sm)
*all telecommuters will be required to adhere to unitedhealth group’s telecommuter policy.
Colorado residents only: the salary range for colorado residents is $94,500 to $171,700Pay is based on several factors including but not limited to education, work experience, certifications, etcIn 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 workplaceCandidates are required to pass a drug test before beginning employment.
Job keywords: associate director claims business process, telecommute, telecommuter, telecommuting, work at home, work from home, remote, seattle, wa, washington
