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Company:
 
UnitedHealth Group
Company Profile | Current Opportunities (381)
Job Location(s): Cypress
Employment Term: Regular
Employment TypeFull Time
Start Date:As soon as possible
Starting Salary Range:Not Provided
Required Experience: Open
Related Categories:Insurance - Management, Insurance - Claims, Executive/Senior Level Mgmt

Position Description

Assoc Dir Claims-330943
Description
UnitedHealthcare is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. When you work with UnitedHealthcare, what you do matters. It's that simpleand it's that challenging. In providing consumer-oriented health benefit plans to millions of people, our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system. Regardless of your role at UnitedHealthcare, the support you feel all around you will enable you to do what you do with energy, integrity, and confidence. So take the first step in what is sure to be a fast paced and highly diversified career.
Responsibilities:
  • Serve as a liaison to one of our largest Northern California Providers and UHC provider relations teams that will manage all inventory receipts and prioritize work for the transaction processing team.
  • Manage significant non-standard claim and appeal submissions.
  • Craft correspondence related to indemnified claims issues.
  • Clarify correct pricing based on contract provisions for indemnified claims and draft flowcharts, policy, job aids and procedures/policies.
  • Continually update lessons learned, corrective actions.
  • Coordinate with quality on claims payment accuracy improvements.
  • Serve as a witness in arbitration/depositions as needed.
  • Liason between several departments including: Legal, Provider Relations, Transaction Processing, and Finance on issues related to indemnified claims.
  • Prepare and present progress reports on projects for senior management, other business partners and vendor partners; validate and present data/findings to all levels of the organization.
  • Work with Network management to identify operational issues in contract language
  • Self-initiate claims processing improvement projects on non-standard processes
Qualifications
  • Undergraduate degree or equivalent experience required; advanced degree preferred.
  • At least 9-10 years of financial and operational claims experience in the managed care and/or health care industries.
  • Demonstrated experience diagnosing project issues and providing proactive project risk management.
  • Ability to manage multiple projects in a complex, matrixed environment.
  • Must have extremely strong reconciliation skills to track thousands of claim lines in a spreadsheet and ensure continued progress of reconciliation project(s).
  • Demonstrated background in data analysis and the use of spreadsheet applications to summarize results; understand the importance of excellent and complete documentation in the spreadsheets and correspondence.
  • Able to review spreadsheets for accuracy/reasonableness and write letters summarizing the spreadsheets.
  • Proficiency with the MS Office suite, including advanced Excel skills.
  • Experience working with Oracle or PeopleSoft financials is desired.
  • Excellent written and verbal communication skills.
  • Experience effectively communicating project/program missions and objectives; ability to build and maintain trusted relationships.
  • Available for travel to Sacramento (approximately once/quarter).
UnitedHealthcare is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.



When you work with UnitedHealthcare, what you do matters. It's that simple... and it's that challenging.



In providing consumer-oriented health benefit plans to millions of people, our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system.



Regardless of your role at UnitedHealthcare, the support you feel all around you will enable you to do what you do with energy, integrity, and confidence. So take the first step in what is sure to be a fast paced and highly diversified career.



Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Job Claim Operations
Primary LocationUS-CA-Cypress
Other LocationsUS-TX-San Antonio
Organization Provider Service
Schedule Full-time
Number of Openings 1

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