Quality Claims Manager

UnitedHealth Group•Tampa, FL

3d•$72,800 - $130,000•Remote

About The Position

The Quality Claims Manager leads the day-to-day work of the Claims Quality team and is accountable for quality planning, assurance, control, and continuous improvement across Medical, Dental, and Pharmacy Claims. The position provides people leadership, directs claims-quality audits and calibrations, monitors quality and operational performance, strengthens governance and controls, coordinates issue remediation, and turns findings into clear actions for operational and senior leaders. The manager sets team direction, prioritizes work, develops employees, resolves operational and quality issues, and adapts plans to changing business needs. The role partners with Claims Operations, Clinical Quality, Compliance, Program Integrity, Analytics, Training, technology teams, and external claims partners to improve accuracy, reduce risk, maintain audit readiness, and support reliable claims outcomes. This is a national remote, full-time position. Employees work Monday through Friday and must be flexible to work an 8-hour shift during normal business hours of 8:00 a.m. to 5:00 p.m. CST. Occasional overtime may be necessary. The role includes six weeks of virtual on-the-job training from home, Monday through Friday, from 8:00 a.m. to 5:00 p.m. CST. Remote employees must maintain a dedicated, private work area, secure sensitive documents, and have access to approved high-speed internet. The salary range is $72,800 to $130,000 annually, based on full-time employment.

Requirements

High school diploma/GED or equivalent work experience.
Must be at least 18 years of age.
At least 3 years of healthcare claims experience involving Medical, Dental, Pharmacy, or comparable claims operations.
At least 2 years of people-leadership experience, including direct-report management, SME, or formal team-lead responsibility for workload, performance, coaching, development, and coverage.
At least 2 years of quality assurance, claims auditing, compliance monitoring, or operational quality experience.
At least 2 years of experience leading or supporting claims audits, quality monitoring, calibration, Audit-the-Auditor, error trending, or remediation.
At least 2 years of experience identifying quality or operational issues and coordinating root-cause analysis, corrective actions, and follow-up.
At least 2 years of experience using performance metrics, audit findings, or operational data to identify trends and recommend actions.
At least 1 year of experience working across Operations, Quality, Compliance, Analytics, Clinical, or other cross-functional stakeholders.
Intermediate proficiency with Microsoft Excel, including filtering, sorting, pivot tables, charts, and structured-data analysis.
Proficiency with Microsoft Word, PowerPoint, Teams, and SharePoint.
Ability to work full-time Monday through Friday and be flexible to work an 8-hour shift during normal business hours of 8:00 a.m. to 5:00 p.m. CST; occasional overtime may be necessary.
Ability to secure company-sensitive documents, if applicable, and maintain a dedicated work area separated from other living areas that provides information privacy.
Must live in a location that can receive a UnitedHealth Group-approved high-speed internet connection or have existing high-speed internet service.
Ability to manage competing priorities, meet deadlines, communicate risk, and maintain accurate documentation.
Remote employees must adhere to UnitedHealth Group’s Telecommuter Policy.
Candidates must pass a drug test before beginning employment.

Nice To Haves

Experience managing a Claims Quality, healthcare quality, claims audit, or operational quality team.
Experience across more than one claims domain, such as Medical, Dental, or Pharmacy Claims.
Experience supporting government healthcare programs, government contracts, Veterans Affairs programs, or another highly regulated healthcare environment.
Experience developing or maintaining quality dashboards, governance scorecards, control inventories, control matrices, risk registers, or monitoring frameworks.
Experience with ServiceNow, Smartsheet, claims audit platforms, or comparable workflow and issue-management tools.
Experience with process mapping, business requirements, change management, audit readiness, or business continuity planning.
Working knowledge of healthcare claims concepts such as eligibility, provider validation, billing, coding, modifiers, duplicate claims, denials, routing, aging, and payment accuracy.
Lean Six Sigma or comparable quality, process-improvement, project-management, audit, or healthcare certification.

Responsibilities

Lead and manage the Claims Quality team by setting priorities, allocating workload, monitoring performance and capacity, coaching employees, supporting development, and ensuring operational coverage.
Oversee Claims Quality activities across Medical, Dental, and Pharmacy Claims, including audits, sampling, findings, trends, follow-up, and audit performance.
Lead internal and external audit calibration and quality-governance activities to promote consistent audit methodology, scoring, interpretation, and resolution of discrepancies.
Monitor quality performance and analyze audit findings, defects, trends, and operational data to identify risks, recurring issues, improvement opportunities, and recommended actions.
Lead quality issue management and corrective actions, including root-cause analysis, remediation planning, escalation, follow-up, and effectiveness monitoring.
Develop and strengthen operational and quality controls by identifying control gaps, monitoring risks, establishing oversight, and supporting audit and compliance readiness.
Oversee Claims Quality reporting and governance, translating quality metrics, audit results, controls, risks, and operational issues into recommendations and executive-level information.
Lead continuous-improvement initiatives to improve claims accuracy, reduce defects and rework, strengthen processes and controls, and improve operational effectiveness.
Partner with Claims Operations, Clinical Quality, Compliance, Program Integrity, Analytics, Training, technology teams, and external partners to resolve issues and advance Claims Quality objectives.
Maintain quality documentation and knowledge management, including work instructions, process documentation, training resources, audit evidence, and controlled records.
Complete ad hoc projects and conduct special project audits and reviews requested by other departments or regions.