Director of M&R Claim Operations – Remote

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

 

This position is responsible for leading and directing a claims operations team of 300+ employees to ensure delivery of our contractual regulatory commitments for the UHC Medicare and Retirement Health plans. Acts as the primary point of contact for Medicare and Retirement for new business implementation, regulatory contract requirements and critical issue resolution. Manages and drives activities related to the UHC Medicare and Retirement Claim functions for health plans, ensuring operational contract compliance as defined by CMS and retirement plans.

 

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

 

Primary Responsibilities:

• Closely monitors and leads ongoing review of claim adjudication metrics, performance, improvements, and issues with business partners and claim teams
• Works closely with the UHC Operations Business Partners and cross functional teams to accomplish organizational goals and to meet the contractual needs as defined by CMS
• Serves as the primary contact with the health plans and business partners on the implementation of new or expanding business
• Conducts root cause analysis on claims that contribute to decrease in performance and failure to meet commitments to understand reasons for not meeting requirements, as well as developing action plans to address the issues/gaps with the cross functional teams
• Develops and executes plans to improve existing performance and efficiency in operational processes
• Leads large, complex projects to achieve key business segment objectives
• Oversees the operational aspects of new product implementations to ensure operational contract compliance
• Monitors performance results and works with the cross functional teams to address gaps in performance
• Provides support and coordinates with UHC Benefit Operations for any claims needs in audits or regulatory inquiries
• Responsible for operational management, meeting our commitments, supporting strategy development for the group and enhancing our capabilities 

 

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:

• 10+ years of claims experience
• 5+ years of leadership experience, managing direct reports, in a growing environment with continuous build out of processes
• Proven ability to manage and drive large scale team performance (150+)
• Demonstrated track record of generating results and having an impact on organizations
• Proven problem-solving skills and ability to translate knowledge to operations
• Demonstrated ability to interface and present to senior management effectively
• Ability to manage multiple tasks and priorities in a matrix environment, solid problem-solving skills and attention to detail
• Excellent communication (both written and verbal) skills
• Medicaid, Medicare, Long Term Care and/or government health plan experience a plus
• 25% travel

 

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

 

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits re subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $132,200 to $226,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.

 

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

 

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission. 

 

 

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.    

 

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