Director, Payment Integrity Product Enablement and Delivery

Director, Payment Integrity Product Enablement and Delivery- Dublin or Letterkenny/ Hybrid

Optum is a global organisation that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together. 

About the Role:

As a Fortune 5 business, we’re one of the world’s leading healthcare companies. There are no limits here on the resources you’ll have or the challenges you’ll encounter.

We have been supporting global healthcare systems from Ireland and the UK for more than 20 years, building a dynamic and diverse team of more than 2,100 talented individuals. With a continued record of growth and stability, we’re on the constant lookout for fresh talent to join our expanding teams.

The Director, Payment Integrity Product Enablement and Delivery provides oversight of all Non-Clinical Optum PI operations. Responsibilities include create, maintain, and implement tools for the oversight of key performance measures and metrics, seeking opportunities to improve on existing reporting, reduce duplication and provide in depth analysis of the metrics for discussion and trend identification/ mitigation. Oversight, monitoring and reporting of all end-to-end business process activities, deep dive of business processes and understanding of unintended consequences of changes made. Identify opportunities for process improvements where metrics are missed and use data to provide early warning of potential imminent misses in metrics or the build op of work backlogs. The ability to anticipate adverse effects of process issues and to provide senior leadership with outlined plans for reducing / removing risks as they are identified. Be instrumental in the building of relationships to gain data access and attend /organize update calls as required. Diagnose process improvement opportunities and leverage communication skills to ensure business partners are forthcoming with data and updates. Communicate results at senior level and maintain transparent and open dialogue across multiple business units simultaneously. This position is also responsible for developing plans and programs to support continuous improvement within UHC PI and seeking to further develop accuracy and timeliness of reports. Participate in meetings that support interfacing activities with PI Operations and remain in close contact with business partners leveraging that relationship for greater UHG efficiency.

Careers with Optum offer flexible work arrangements and individuals who live and work in the Republic of Ireland will have the opportunity to split their monthly work hours between our Dublin or Letterkenny and telecommuting from a home-based office in a hybrid work model. 

Primary Responsibilities:

•    Key point of contact for all aspects of Non-Clinical oversight which includes oversight, monitoring and quality for key performance measures and metrics for each line of business. Drives related reporting and updates for all LOB’s and Value Streams to support UHC PI management in ongoing operational decision making and to lead communication and regular update meetings.
•    Support the creation and delivery of dashboards and reports on business partner performance against key metrics, SLA’s and other defined performance measures across multiple LOB’s and business segments. Ensuring accuracy of data at all times and verifying where anomalies are identified. 
•    Identify and drive efficiencies through ensuring business partner goals, KPI’s and SLA’s are met or exceeded and that work product is conducted to the highest quality.

•    Scope of role responsibilities include the following core elements:
•    Drives Non-Clinical oversight, review, and report implementation for UHC PI.  Supports the timely execution of metric reporting and treats as a priority, areas where misses exist or are imminent.
•    Active and engaged in leading meetings with business stakeholders as needed across UHG on measures and outcomes and ensures communication strategies are aligned across each of the business units and LOB’s so partners have consistency in messaging.
•    Engaged in the development of management reporting to identify meaningful metrics that provide insight into root cause impacts and trending.
•    Ensure SLA’s, KPI’s and other measures (including incidents and escalations) are relevant and conduct regular review of same for changing business needs or the accommodation of additional data streams.  Recognizes internal impact(s) of outcomes and provides messaging to upper management based upon identified issues.
•    Leverages the oversight of delegated activities to ensure that Regulatory and Compliance issues are identified, reported, and acted upon in a timely manner, with participation in subsequent meetings to oversee activities taken to ensure non-repeat of breaches. 
•    On-going active engagement required to resolve barriers or issues in a timely manner while maintaining relationships and integrity.  
•    Supports the Senior Director by assisting in the prioritization and delivery of ideation concepts, as required.
•    Key point of contact for all aspects of Non-Clinical oversight which includes oversight, monitoring and quality for key performance measures and metrics for each line of business. Drives related reporting and updates for all LOB’s and Value Streams to support UHC PI management in ongoing operational decision making and to lead communication and regular update meetings.
•    Support the creation and delivery of dashboards and reports on business partner performance against key metrics, SLA’s and other defined performance measures across multiple LOB’s and business segments. Ensuring accuracy of data at all times and verifying where anomalies are identified. 
•    Identify and drive efficiencies through ensuring business partner goals, KPI’s and SLA’s are met or exceeded and that work product is conducted to the highest quality.
•    Scope of role responsibilities include the following core elements:
•    Drives Non-Clinical oversight, review, and report implementation for UHC PI.  Supports the timely execution of metric reporting and treats as a priority, areas where misses exist or are imminent.
•    Active and engaged in leading meetings with business stakeholders as needed across UHG on measures and outcomes and ensures communication strategies are aligned across each of the business units and LOB’s so partners have consistency in messaging.
•    Engaged in the development of management reporting to identify meaningful metrics that provide insight into root cause impacts and trending.
•    Ensure SLA’s, KPI’s and other measures (including incidents and escalations) are relevant and conduct regular review of same for changing business needs or the accommodation of additional data streams.  Recognizes internal impact(s) of outcomes and provides messaging to upper management based upon identified issues.
•    Leverages the oversight of delegated activities to ensure that Regulatory and Compliance issues are identified, reported, and acted upon in a timely manner, with participation in subsequent meetings to oversee activities taken to ensure non-repeat of breaches. 
•    On-going active engagement required to resolve barriers or issues in a timely manner while maintaining relationships and integrity.  
•    Supports the Senior Director by assisting in the prioritization and delivery of ideation concepts, as required.

You will be rewarded and recognised 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 providing development for other roles you may be interested in.

Required Qualifications:

•    Undergraduate degree or equivalent experience. 
•    Previous operational experience.
•    Experience in Process excellence and identifying gaps.
•    Involvement with Claims related initiatives that involve complex regulatory requirements 
•    Ability to assist with the management and coordination of divergent business priorities with lean resources.
•    Participate in and support the navigating of complex stakeholder relationships in a matrix environment with politically sensitive concerns.
•    Strong communication skill sets, with the ability to support and present information in a variety of different formats to all levels of stakeholders.
•    Strong analytical skills, with Experience in analysis and oversight of business units.
•    Ability to articulate dashboard and reporting needs and engage with supporting teams to create and utilize these.
•    Translate captured metric reporting into meaningful dialogue identifying efficiency of workflows and practices.
•    Provide input into and/or develop relevant metric and oversight mechanisms and/or work tools to support new or updated business processes.

Please note you must currently be eligible to work and remain indefinitely without any restrictions in the country to which you are making an application. Proof will be required to support your application.

All telecommuters will be required to adhere to the UnitedHealth Group’s Telecommuter Policy.

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 marginalised 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.

Diversity creates a healthier atmosphere: Optum is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to gender, civil status, family status, sexual orientation, disability, religion, age, race, and membership of the Traveller community, or any other characteristic protected by law. Optum is a drug-free workplace. © 2024 Optum Services (Ireland) Limited. All rights reserved.