Director of Claim Operations Performance - Remote - 2276102

Company: UnitedHealth Group
Location: Eden Prairie
Posted on: April 6, 2025

Job Description:

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.Position in this function is responsible for representing claim processing services and performance internally to RBE leadership and externally to client RBE markets, payors and regulatory entities. Positions in this function play a critical role in ability to deliver claim processing services to clients and to manage internal business cross-capability partnerships to execute on client commitments and performance measures. Accountable for delivering scalable, sustainable, financially sound solutions that solve client requirements and enable successful claims processing services product delivery and/or internal business function performance, while driving adoption with internal business partners.You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities:

• Represent Claim Operations business performance and improvement initiatives in internal and external business performance reviews
  • Develops targeted relationships with senior market leaders and client-payors relevant to claim processing operations.
  • Represents claim operations performance in market/Regional client JOCs/reports, client-payor facing JOCs and internal business reviews with senior RBE leadership.
  • Develops 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.
    • Drives engagement with technology and/or partner capability teams on requirements and approach for desired business outcomes.
    • Expert resource working with OptumCare capability teams driving process/tool changes to scale and mature the RBE operation to improve efficiency and quality of service to markets, payors, providers and members.
    • Expand claim adjudication functionality and automation across the business
      • Acts as claim capabilities expert leader and mentor within the organization; Takes a broad business approach; Is a resource to senior leadership.
      • Monitors claim processing tech stack capabilities to validate relevance and desired impact on target business strategies; makes 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
        • Demonstrate knowledge of applicable legal/compliance requirements, and the penalties associated with non-compliance (e.g., HIPAA, CMS, state regulations, performance guarantees, service level agreements).
        • Maintain awareness of changes to applicable laws and regulations impacting claims business processes (e.g., Healthcare Reform/PPACA, CMS, state regulations).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:
          • 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. Enabling appropriate operational controls and metrics.Preferred Qualifications:
            • Experience with multiple products (Medicare, Medicaid, Duals, Commercial).
            • Experience working across multiple Health Plan payors.
            • Experience with Facets claim adjudication platform.*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.The salary range for this role is $124,500 to $239,400 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.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.Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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Keywords: UnitedHealth Group, Rochester , Director of Claim Operations Performance - Remote - 2276102, Executive , Eden Prairie, Minnesota