Director of Claim Operations Performance

UnitedHealth GroupEden Prairie, MN
281d$124,500 - $239,400Remote

About The Position

Optum is a global organization 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. On the one hand, no industry is moving faster than health care. On the other, no organization is better positioned to lead health care forward than Optum and UnitedHealth Group. That's what makes this opportunity so applause worthy. We have hundreds of business verticals across our matrixed organizations that are bringing thousands of new ideas, services and products to the marketplace every year. Our goal is simple. Use data and technology to help drive change and make the health care system work better for everyone. When you join us as a Director of Claim Operations Performance, you'll be engaged in a complex business model that is highly adaptable to build solutions that meet their customer needs in a competitive and effective way. This role will challenge your ability to work in a complex environment of claim processing operations where we are expanding capabilities rapidly to meet customer requirements and grow the business. You'll need flexibility, agility and the ability to adapt to change while maintaining solid relationships with stakeholders in a highly cross-matrixed environment.

Requirements

  • 15+ years of experience in claim operations (medical claims preferred) with progressive leadership responsibility
  • Client relationship management experience - communicating product performance and planned enhancements to increase business value
  • Vendor management experience
  • Demonstrated experience designing complex business operations/processes - with focus on scale to enable cost-controlled growth

Nice To Haves

  • Experience with multiple products (Medicare, Medicaid, Duals, Commercial)
  • Experience working across multiple Health Plan payors
  • Experience with Facets claim adjudication platform

Responsibilities

  • Represent Claim Operations business performance and improvement initiatives in internal and external business performance reviews
  • Develop targeted relationships with senior market leaders and client-payors relevant to claim processing operations
  • Represent claim operations performance in market/Regional client JOCs/reports, client-payor facing JOCs and internal business reviews with senior RBE leadership
  • Develop strategy to continually improve market and payor communication touchpoints, looking for value-add topics to expand dialog and strengthen RBE relationships
  • Represent claim MedEx financial summaries to client Finance-Actuary teams for purposes of forecasting claim payment reserves, as well to communicate impacts of special cause and program/process changes impacting reserve forecasting
  • Enable business growth through influencing claim operating solutions to meet requirements
  • Advanced proficiency in developing and executing complex claim operating strategies/solutions based on market/payor requirements, as well as steady state complex initiatives to drive efficiencies/affordability measured by cost/benefit, business value, and service targets
  • Drive engagement with technology and/or partner capability teams on requirements and approach for desired business outcomes
  • Act as claim capabilities expert leader and mentor within the organization; Take a broad business approach; Be a resource to senior leadership
  • Monitor claim processing tech stack capabilities to validate relevance and desired impact on target business strategies; make recommendations on whether to maintain, invest, scale, or de-invest
  • Lead cross-enterprise initiatives to advance utilization of adjudication platform functionality to streamline process/automate and to improve claim outcomes quality
  • Demonstrate knowledge of applicable laws and regulations impacting claims business processes

Benefits

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