Claims Supervisor

UnitedHealth Group • Los Angeles, CA

291d • $49,300 - $96,400 • Remote

About The Position

Optum CA is seeking a Claims Supervisor to join our team in California. Optum is a clinician-led care organization that is changing the way clinicians work and live. As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone. At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

Requirements

• High School Diploma / GED.
• Must be 18 years of age OR older.
• 3+ years of experience in claims processing.
• Understanding of reimbursement methodologies and standard payment fee schedules (Medi-Cal, Medicare, RBRVS).
• Familiarity with Claims coding/unbundling software.
• Working knowledge of word processing and spreadsheet development.
• Ability to interact positively with staff and other SCPMCS management.
• Ability to work any of our 10-hour shift schedules during the normal business hours of 5:45 AM - 4:15 PM PST from Monday - Thursday.

Nice To Haves

• Previous Supervisor experience.

Responsibilities

• Supervises the activities and production/quality of the Claims Auditors.
• Ensures accurate and timely review of PDRs, Member Denials, and claims compliance.
• Ensures member maximum out of pocket notification are appropriately handled through reprocessing/reimbursement of claims and coordination with Finance.
• Supervises the activities and production/quality of outsourced claims analysts; acts as liaison with the Calibrated claims manager.
• Is the primary Claims Department resource for other SCPMCS departments regarding processing questions.
• Assists the Claims Manager in completing health plan inquiries and helps monitor HPInqClaims mailbox.
• Coordinates the daily check runs; collaborates with Finance to coordinate the weekly check run schedule for claims and voids to comply with regulated timeliness guidelines and within Client specifications.
• Assists the Claims Manager in policy/procedure review and revision as indicated.
• Uses CQI (Continuous Quality Improvement) principles as a guideline for assessing and re-assessing procedures and process with the goal towards increased productivity, quality outcomes, and cost effectiveness.
• Other duties as assigned.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution.

What This Job Offers

• Job Type: Full-time
• Career Level: Manager
• Industry: Insurance Carriers and Related Activities
• Education Level: High school or GED