Claims Operations Manager,

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

About the role

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. As the Claims Manager, you'll help identify and overcome errors in claims processing while ensuring adherence to compliance policies. This role is responsible for oversight of management and administration of multiple areas that impact benefit configuration and/or claims functions, ensuring prompt and accurate provider claims processing in accordance with state requirements.

You will collaborate with the CIO and Data Director to ensure timely and accurate submission of encounter data, handle interactions with providers and claims management staff regarding claims inquiries, and work on end-to-end provider claim quality, physician portal usability, and external provider education programs.

Responsibilities

• Analyze metrics and trends to proactively identify gaps in claims adjudication; work with matrix partners to improve performance and present alternative solutions.
• Provide subject matter expertise on claims adjudication and benefit configuration inquiries.
• Oversee end-to-end adjudication of claims.
• Coordinate, lead, and complete projects across various functional areas.
• Navigate a challenging matrix environment, lead multi-faceted and multi-functional teams, and motivate others in problem resolution.
• Identify opportunities for innovation, productivity improvement, and savings.
• Work directly with health plan leadership and claims/benefit leadership to drive process improvements.
• Create clear and concise written and oral communication, including presentations to management detailing project status, risks, issues, scope, and timeline.
• Ensure projects are completed on time and within 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.
• Lead operational strategy to reduce costs while improving customer experience.
• Lead project management and implementation initiatives.
• Adhere to applicable policies and procedures regarding claims adjudication (e.g., reimbursement, claims, appeals, credentialing, complaints, medical policies, benefits design, regulatory requirements, client business rules).
• Stay current on industry-related trends and/or events (e.g., regulations, health care reform).
• Comply with and use relevant computer and software applications (e.g., MS Office, storage).

Requirements

• 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 leadership / supervisory experience in healthcare claims operations.
• Proficient skills with Microsoft Word, Excel (including pivot tables), and PowerPoint.
• Ability to work full time (40 hours/week) Monday - Friday, with flexibility to work any 8-hour shift during normal business hours (8:00 AM - 5:00 PM); occasional overtime may be required.

Preferred Qualifications

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

The salary for this role ranges from $91,700 - $163,700 annually based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, and certifications.

Benefits

In addition to your salary, we offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements).

Schedule

• Full-time (40 hours/week), Monday - Friday.
• Hybrid work arrangement with 4 in-office days per week; specific onsite schedule determined based on business needs.