Position Description:

Flexible? Friendly? Fast on your feet? That's a great start. Accurate? Accountable? Self-Directed? These traits can take you places. Our claims operations are the focal point of handling information about services patients receive and the way those services get paid. It's complex, detailed work. It's fast paced challenge. It's a job that calls on you to be thoughtful, resourceful, team-driven and customer-focused. To put it mildly, there is never a dull moment.

Primary Responsibilities:

• Provide expertise and/or general claims support to teams in reviewing, researching, negotiating, processing and adjusting claims
• Authorize appropriate payment or refer claims to investigators for further review
• Analyze and identify trends and provides reports as necessary
• Consistently meet established productivity, schedule adherence, and quality standards
• Respond to claims appeals
• Supervise, monitor, track and direct day to day operations to staff
• Consistently meet established productivity, schedule adherence, and quality standards
• Respond to claims appeals
• Supervise, monitor, track and direct day to day operations to staff
• Consistently meet established productivity, schedule adherence, and quality standards
• Serve as first point of escalation for SME's on procedural and technical issues; coach staff regarding how to effectively resolve the issue(s)
• Maintain a positive work environment that supports a quality driven team and identify any issues that may inhibit performance
• Motivate individuals and teams to process claims in a timely manner
• Partner with staff and other leaders to develop improvements
• Involvement in the development of improvement plans for their staff with the assistance of a business manager
• Partner with the Quality organization to develop improvement plans for their respective area
• Facilitate daily meetings to communicate team performance goals/results
• Assume accountability for ensuring individuals/team meet their performance metric goals
• Investigate trends, surface issues, identify root problem and collaboratively work with specific team/individuals to resolve issues
• Use a balanced scorecard to manage the team's performance
• Provide regular performance reports to the Business Manager
• Ensure team supports and adheres to all improvement initiatives
• Provide formal and informal performance feedback to individuals and the team; conduct semi-annual performance reviews
• Provide coaching to associates based on quality results; develop improvement plans when needed
• Coach employees to identify and develop career goals; assist employee development
• Partner with T/QA team to identify skill development needs associated with performance and ensure employees receive appropriate coaching and training
• Partner with T/QA team to identify skill development needs associated with career development opportunities
• Identify high potential staff for succession planning Perform Human Resource administrative duties
• Partner with Business Manager to recruit, develop and manage a high caliber workforce with minimal turnover
• Incent and reward individuals based on contribution and performance

Requirements:

• HS Diploma/GED
• 1+ yrs Experience as a Team Lead, Supervisor, or Manager
• 1+ yrs Experience analyzing data (Should have experience analyzing data and spotting trends or gaps that can be used to increase a team’s efficiency)
• Project Management Experience (This person did not have to lead the project or act as a manager but had to have at least participated on a project)
• Intermediate level of proficiency MS Word, Excel, & PowerPoint (Word is used to create professional documents for both external and internal consumption.  Excel is used for reporting and the analysis of data pertinent to team production.  They must be able to sort, filter and display that data into visual forms for presentations.  This person should be able to create PowerPoint decks from scratch)
• Work Hours: Monday thru Friday 8 AM to 5 PM (Some flexibility required as it does require longer than 40 hour )

Assets:

• Bachelors degree preferred
• Claims processing experience within a healthcare environment is preferred
• Knowledge of Medical Terminology preferred

Physical Requirements and Work Environment:

• Extended periods of sitting at a computer and use of hands/fingers across keyboard or mouse
• Office environment
  

UnitedHealthcare, part of the UnitedHealth Group family of companies, is comprised of three specialized businesses dedicated to meeting the health care benefits needs of individuals and groups; all part of something greater, but each with a specialized focus:

UnitedHealthcare Employer & Individual works with individuals, small businesses and large multi-site employers to provide innovative, affordable benefits services.

UnitedHealthcare Medicare & Retirement is focused on serving Americans over the age of 50. It is the largest business dedicated to meeting the growing health and well-being needs of aging individuals in the nation, serving one in five Medicare beneficiaries through a comprehensive and diversified array of products and services through four industry-leading businesses.

UnitedHealthcare Community & State provides high-quality, personalized, public-sector health care programs that help local government agencies improve health outcomes for millions of children and low-income and disabled individuals at an affordable cost.

Together, we're removing the barriers that keep people from receiving the kind of quality health care that makes a difference. We focus on Integrity, Compassion, Relationships, Innovation and Performance as we empower people to achieve better health and well-being.

Come grow and thrive in our culture of innovation and ideas. Because there is no opportunity greater than the quest to help people live healthier lives.

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.