Claims Operations Manager

Claims Manager

This position follows a hybrid schedule with (4) in-office days per week. Our office is located at 115 W. Washington St., Indianapolis, Indiana 46204.

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.

As the Claims Manager, you'll help identify and overcome errors in claims processing while ensuring adherence to compliance policies.

The Claims Manager is responsible for oversight of management and administration of multiple areas that impact benefit configuration and/or claims functions. As you take on this task, you'll be responsible for ensuring prompt and accurate provider claims processing in accordance with state requirements. This individual shall work in collaboration with the CIO and Data Director to ensure the timely and accurate submission of encounter data.

Handles interactions with providers and claims management staff regarding provider claims inquiries or requests for assistance with claims issues, including working on end-to-end provider claim and call quality, ease of use of physician portal and future service enhancements, and training and development of external provider education programs regarding claims submission processes.

This position is full time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime. Our office is located at 115 W. Washington St., Indianapolis, IN 46204. This role follows a hybrid work arrangement, with some in-office days required. The specific onsite schedule will be determined based on business needs and communicated by leadership.

Primary Responsibilities:

• Analyze metrics and trends to proactively identify gaps in claims adjudication - working with matrix partners to improve performance and present potential alternative solutions as appropriate
• Provides subject matter expertise on claims adjudication and benefit configuration inquiries
• Oversees end-to-end adjudication of claims
• Coordinates, leads, and completes projects across various functional areas
• Navigate a challenging matrix environment, lead multi-faceted and multi-functional teams with a strong ability to problem solve and lead and motivate others in problem resolution
• Identify opportunities for innovation, productivity improvement and savings
• Will work directly with health plan leadership and claims/benefit leadership as you drive changes and improvements to the process.
• Creates clear and concise written and oral communication, including presentations to management, that details project status, risks, issues, scope and timeline
• Ensures projects are completed on time and in scope.
• Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance
• Provide expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims
• Leads operational strategy to reduce costs while improving customer experience
• Lead project management and implementation initiatives
• Adheres to applicable policies and procedures regarding claims adjudication (e.g., reimbursement; claims; appeals; credentialing; complaints; medical policies; benefits design; regulatory requirements; client business rules.
• Stays current on industry-related trends and/or events (e.g., regulations; health care reform)
• Complies with and uses relevant computer and software applications (e.g., MS Office; storage)

Required Qualifications:

• High school diploma / GED OR equivalent work experience
• Must be 18 years of age OR older
• 3+ years of experience in claims adjudication (e.g. adjustments, appeals, etc.)
• 3+ years of experience conducting healthcare claims research and resolution
• 3+ years of experience with medical billing, coding, and reimbursement policies
• 2+ years of experience in leadership / supervisory experience in healthcare claims operations
• Proficient skills with Microsoft Word (create and edit documents and add visual aids), Microsoft Excel (create, edit, sort, filter, create pivot tables), and Microsoft PowerPoint (create and edit presentation)
• Ability to work full time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications:

• 3+ years of experience in provider relations knowledge (e.g., language; terminology; processes; methodology)
• Understanding of claims processing systems CSP Facets
• Certified Professional Coder

Telecommuting Requirements:

• Reside within commutable distance to the office at 115 W Washington St. Indianapolis, IN 46204
• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.