Operations Service Manager

This position is National Remote. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

UMR, UnitedHealthcare’s third-party administrator (TPA) solution, is the nation’s largest TPA. When you work with UMR, what you do matters. It’s that simple . . . and it’s that rewarding.

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. Opportunities are endless for your career development and advancement within UMR due to our record-breaking growth.

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

Positions in this function serve as the liaison between the customer and the UMR departments for anything call/claim, and overall operational performance related.

In this role you will identify and resolve operational problems. This includes the ability to use all resources and tools to complete thorough research and reach out to the appropriate department for assistance when necessary. You will also need to ensure the call and claim teams have adequate resources to serve our customers, such as updating DPDB timely, providing customer specific training, and system support and guidance to an external business partner handling member services using UMR’s systems. The Operations Service Manager also maintains the customer’s dental plan installation documents and will test any benefit changes in CPS. Which may require you to consult with other departments i.e.  Account Management and Integration Support to ensure benefit intent is understood. This role is equally challenging and rewarding. You’ll assume the responsibility of servicing a complex, high profile, premier account customer while being part of UMR’s new, unique and exciting TPA model.

This position is full-time (40 hours/week) Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7am – 5pm local time zone. It may be necessary, given the business need, to work occasional overtime.

                                                

Primary Responsibilities:

• Works independently to manage own tasks and apply knowledge/skills to a range of complex activities
• Demonstrates great depth of knowledge/skills in own function and increased knowledge/skills in other functions such as coding, networks, integration, HRA, HCR regulations, etc.
• Proactively identifies non-standard requests and potential problems; investigates and solutions using defined processes, expertise and judgement.  Resolution is determined by use of knowledge, research, and internal contacts
• Identify potential claim and / or customer service issues and create a plan to ensure risk is minimized
• Consults with key business partners outside of the team to ensure benefit intent is understood based on source documents and output matches (coding, SAE, PNO, network services, integration support)
• Serve as the liaison to a complex premier account to manage first level response and resolution of escalated issues with external and internal customers, including a complex business partnership
• Identify and resolve operational problems using undefined processes, expertise and judgment
• Investigate claim and / or customer service issues as identified and communicate resolution to customers
• Responsible for maintaining customer’s dental plans installation documents 
• Responsible for testing customer benefit changes in CPS
• Create and update DPDB’s
• Identify the need for and providing specific and remedial training to internal UMR staff as well as external business partner staff working in
• UMR’s ecosystem
• May act as a resource for others and coordinate other activities

                                                

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:

• High School Diploma / GED 
• Must 18 years of age or older 
• 1+ years of experience in claim processing  
• 1+ years of experience with leading complex analytical projects including presenting findings to internal and/or external leadership level audience
• 1+ years of experience working with multiple internal teams or lines of business  
• Intermediate level of proficiency with MS Office (Excel, Outlook, Teams, Word, PPT) 
• Ability to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 5:00pm in your time zone. It may be necessary, given the business need, to work occasional overtime

                                                

Preferred Qualifications:

• Claims processing experience with CPS (claim processing system for UMR) (UMR is UnitedHealthcare’s third-party administrator (TPA) solution and you must be or have been an employee of UMR specifically to have experience with the UMR claims system)
• Experience with dental healthcare processes
• Knowledge of the OSM position

                                                

Telecommuting Requirements:

• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service

                                                

Soft Skills:

• Capability to provide leadership and direction to individuals and regarding complex situations requiring investigation
• Analytical, problem – solving and decision – making skills
• Communication and interpersonal skills
• Experience planning, organizing, setting priorities, and meeting deadlines while handling multiple work assignments

                                                

*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 are 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 hourly pay for this role will range from $23.41 – $41.83 per hour 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.

                                                

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