Transforming health care for everyone takes a huge effort. But we never said major impact was easy. At UnitedHealthcare, We are working to create a system that is connected, aligned and more affordable for all involved. One that delivers high quality care, responsive to the needs of each person and the communities in which they live. And as part of the UnitedHealth Group family of businesses, we have the support and resources of a Fortune 6 industry leader to do so.
Positions in this function are responsible for all related aspects of claim system processes and claim business rules. Includes claims system utilization, capacity analyses/planning and reporting. Includes claims-related business and system analysis. Ensures data integrity, data security and process optimization.
Prepay/Postpay FWAE AD role that will serve as client-facing Lead for client Commercial and government implementations and ongoing operational delivery functions. Once contract is live with steady state, will lead operation supervisor(s), clinical and non-clinical resources and business analyst(s) to ensure data integrity, data security, and process optimization/operational delivery against commercial and/or government client deiverables driving high NPS scores. Will partner with Sales, AAL, Ideation, and S&T to manage client contract and deliverables. Client facing role that will support RFP's, QBRs, and consulting for future business.
You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Provide leadership over Commercial and/or Government operations teams to ensure delivery on contractual deliverables of clients
- Provide client-facing support as necessary during implementations and ongoing steady state activities to ensure high NPS
- Lead project and relationship management for one or more of our large, multi-year contracts, coordination and quality assurance for all services delivered and ongoing opportunity identification and development
- Lead the implementation of recovery and cost containment activities
- Provide account management and partnership with sales to ensure that the appropriate processes are in place, proper follow up with the client is occurring for operational delivery
- Drive favorable algorithm outcomes by partnering with AAL to provide policy expertise which will drive client savings and revenue
- Effectively plan staff responsibilities and manage activities, utilizing staff resources to meet client goals in accordance with established contractual deliverables while achieving both revenue and IOI targets
- Lead and Collaborate with the operations team to drive investigating, recovering and resolving a wide variety of recoupment for Commercial , Medicaid and Medicare health plans and government entities
- Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance
- Ensure all operational metrics of QA, productivity, timeliness and utilization are met
- Undergraduate degree or 7+ years of HealthCare Leadership
- 7+ years experience working within a health plan and/or managed care business operations
- 5+ years in leadership role with experience in management of supervisors and leaders
- 5+ years of experience tracking and planning projects management disciplines
- 5+ years of client facing experience during a client implementation and ongoing operational support
- 5+ years of experience developing and managing operational metrics
- 5+ years of experience with Federal (Medicaid) and/or state health policy programs
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)
*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy
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.
Job Keywords: FWAE, Medicaid, Customer Facing