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Claims Manager - Eden Prairie, MN
Category: Health Care Industry , Insurance
  • Your pay will be discussed at your interview

Job code: lhw-e0-89829547

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UnitedHealth Group

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  Job posted:   Fri May 18, 2018
  Distance to work:   ? miles
  1 Views, 0 Applications  
Claims Manager - Eden Prairie, MN
Energize your career with one of Healthcare's fastest growing companies. You dream of a great career with a great company - where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it's a dream that definitely can come true.
Already one of the world's leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up. This opportunity is with one of our most exciting business areas: Optum - a growing part of our family of companies that make UnitedHealth Group a Fortune 6 leader.
Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals.
No other business touches so many lives in such a positive way.
And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance. The Claims Manager will be responsible for leading a staff of Non-Clinical investigators who are validating medical records are necessary, requesting them and making pay or deny decisions on Medicare & Retirement claims.
This person will be responsible to oversee staff day to day activities, including timecards, PTO, OT, metrics, inventory management etc.
Additionally they are responsible for employee development, revenue / IOI management of their team, implementation resource, business process enhancement and short and long term strategy for business growth and expansion.
This position is also responsible for ensuring their team meets the necessary compliance hours for FWAE as well as working with the leads to ensure process improvements and p&p's are accurate and updated.
They are responsible for helping with training and working with the manager and leads to ensure the Non-Clinical process meets the needs of our clients.
This position supports, manages and escalates identification of suspected waste & abuse of health insurance claims and ensures claims are accurately handled.
This team member will also be responsible for providing operational support in reporting, process improvements, coaching, internal quality, and special projects.
Primary Responsibilities:Manages team of 15-18 Non-Clinical investigators (non-exempt), including tracking KPI's, metrics, OT, TAT etc., provides feedback to staff on performance, sets direction, resolves problems, provides guidance to team members when needed and takes necessary steps to address poor performance including corrective action up to termination Serves as an operational expert for their business, creating documentation and implementing and approving operational changes through documentation and training the team on the updates.
Sought out as an expert for the business and provides explanations and information to others on difficult issues, both within the team and other departments and solves complex problems, builds innovative solutions and serves as an operational leader in new client implementations and / or expansion of our current business.
Develops innovative approaches and strategies to improve business process through projects, internal and external to our business and adapts the department needs / priorities based on business and operational challenges. Required Qualifications:High School Diploma / GED (or higher) 3+ years of relevant work experience2+ years of leadership and relevant work experience 2+ years of experience coaching, mentoring and providing feedback 1+ years of human resource policies and procedures experience 1+ years of client service experience 1+ year of experience on Cosmos, CPW and / or NICE Proficient in Microsoft Office including Word (keyboarding skills and data entry) and Microsoft Excel (creating spreadsheets and using formulas) with strong computer skills (e.g.
multiple systems experience, trouble-shooting IT concerns, etc.)Preferred Qualifications: 2+ years of Waste and Error M&R team and process experienceHealthcare claims experienceCriminal Justice background and / or certified Fraud Investigation experience Strong communication skills with the ability to interpret data Experience with Fraud Waste & Abuse or Payment Integrity Previous CMS experienceSoft Skills: Highly organized with effective and persuasive and robust communication skills Strong, analytical, problem-solving and decision-making skills; ability to exercise good judgment Open to change and new information; ability to adapt in changing environments and integrate best practicesCareers with Optum.
Here's the idea.
We built an entire organization around one giant objective; make the health system work better for everyone.
So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve.
Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential.
For you, that means working on high performance teams against sophisticated challenges that matter.
Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work. 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. Keywords: COSMOS, Facets and CPW, customer outcomes, manager b55a55ae-c16c-4455-aa02-34591607aafd
*Claims Manager - Eden Prairie, MN*
*Minnesota-Eden Prairie*

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