Associate Director, Pre-Pay Claim Validation - Client Lead - Remote

UnitedHealth Group; Plymouth (MN); Hybrid; USD 113,000 - 193,000; Full time

Job summary

UnitedHealth Group is seeking an Associate Director to lead client-facing operational delivery for pre-pay and post-pay claims review services across multiple commercial clients. You will work with Operations, Clinical and other teams to drive significant savings and ensure program success.

You will have remote-friendly work with in-office four days weekly in Minneapolis or Washington, D.C. and may coordinate globally.

Qualifications

• 5+ years of operational management experience.
• 5+ years of client-facing experience and ongoing operational support.
• 3+ years of experience within the Fraud, Waste, and Abuse space.
• 3+ years of experience with workforce management and staff planning.
• 3+ years of experience indirectly leading a global team.
• 3+ years of experience developing and managing operational metrics.
• 3+ years of experience working within a health plan and/or managed care business operation.
• Certified Coder or RN/LPN (Preferred).

Responsibilities

• Accountable for Inventory, SLAs, productivity via capacity analysis and quality control.
• Lead project and relationship management for one or more large, multi-year contracts with QA for services delivered.
• Identify and manage system issues, data integrity, security controls, and process adherence.
• Work with matrix partners to manage client contract obligations and deliverables.
• Achieve savings, revenue and IOI targets by staffing planning and identifying efficiency opportunities.
• Provide account management and partner with sales to ensure proper client follow-up.
• Drive favorable algorithm outcomes by partnering with R&D to optimize savings and revenue.
• Ensure adherence to state and federal compliance policies and contract requirements.
• Identify and remove operational barriers; conduct deep-dive reviews for improvement.
• Partner with offshore operations to integrate practices and reduce costs.
• Identify and secure resources (funding, staffing, security, real estate, telecommuting).
• Conduct regular meetings with stakeholders to review updates and issues.
• Monitor ongoing compliance and related outcomes for regulators and clients.
• Ensure business continuity and emergency response plans are tested and updated.
• Demonstrate budgeting/forecasting and cost-control capabilities.
• Analyze budget performance and variances; suggest adjustments.
• Collaborate with Finance and Workforce Management to plan resources and budgets.

Skills

Operational management

Client-facing experience

Fraud, Waste & Abuse

Workforce management

Global team leadership

Operational metrics

Health plan operations

Budgeting & forecasting

Job description

OptumInsightis improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, andultimately consumers. Our deepexpertisein the industry and innovative technology empower us to help organizations reduce costs while improving risk management,qualityand revenue growth. Ready to help us deliver results that improve lives? Join us in making healthcare work better for everyone through people-led, responsible AI whileCaring. Connecting. Growing together.

The Associate Director will serve as client-facing lead for operational delivery functions for the pre-pay and Post Pay claims review service for multiple Commercial Clients. The AD will closely partner with Operations Managers, Team Leads, Clinical, Non-Clinical resources, Business Analysts and Matrix Partners. Persons will be responsible for generating approximately $50-$400M in financial savings for Commercial clients in Fraud, Waste, and Error recoveries. This includes indirectly leading staff across multiple levels of staff and multiple functions/departments across one or more business units. Responsibilities include achieving SG&A cost goals, Client service level agreements and reducing unit costs. This includes overall accountability of project execution and performance improvement for a client specific Value Stream process. Individuals will have indirect accountability for large operations both domestically & globally. Responsibilities include day-to-day site operations, manage leadership internal and external to organization, accountable for financial and non-financial results (budgets and actuals), meet regularly with clients and meet operational performance level agreements and compliance regulatory requirements.

You’ll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Day to Day Responsibilities:

• Accountable for Inventory, SLAs, productivity, through capacity analysis planning and quality control
• As client growth and organizational demand dictates, ADs will also lead project and relationship management for the implementation of one or more large, multi-year contracts, with coordination and quality assurance for all services delivered as well as ongoing optimization opportunity identification and development
• Identify and manage system issues, and ensuring data integrity, security controls and process adherence
• Work with matrix partners to manage client contract obligations and deliverables
• Achieve savings, revenue and IOI targets by effectively planning staffing and staff responsibilities as well as identifying efficiency opportunities - both technical and process driven
• Provide account management and partnership with sales to ensure that the appropriate processes are in place and proper follow-up with the client is occurring for operational delivery
• Drive favorable algorithm outcomes by partnering with Research & Development to provide policy expertise which will drive and optimize savings and revenue
• Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance
• Identify & remove operational barriers. Conduct deep dive program reviews with relevant internal and/or external stakeholders to identify opportunities for continuous improvement
• Partner with offshore operations to tightly integrate business practices and deliver services at a more affordable rate, both internally and with our Matrix business partners
• Identify and/or secure resources (e.g., funding; staffing; system security; real estate and/or telecommuting requirements; hardware/software) required to implement programs
• Conduct regular meetings (e.g., External Clients, R&D, Operations) with relevant internal and/or external stakeholders to review and discuss updates and outstanding issues (e.g., project implementation readiness; compliance and/or quality audit results; out-of-compliance issues; staffing issues)
• Monitor and/or report on-going compliance and related outcomes (e.g., claim denials; complaints; clinical metrics) to relevant internal and/or external stakeholders (e.g., regulatory agencies; customers; vendors)
• Ensure that business continuity/emergency response plans are reviewed and tested regularly, up-to-date, and can be readily executed
• Demonstrate understanding of budgeting and forecasting tools and implement cost controls to manage costs
• Analyze budget performance and variances throughout the fiscal year, and recommend and/or make necessary adjustments and corrections
• Work with relevant internal partners (e.g., Finance, Workforce Management) to identify resource requirements and/or create budgets and forecasts

You’llbe 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 asprovidedevelopment for other roles you may be interested in.

Required Qualifications:

• 5+ years of operational management experience
• 5+ years of client-facing experience and ongoing operational support
• 3+ years of experience within the Fraud, Waste, Abuse space
• 3+ years of experience with workforce management and staff planning
• 3+ years of experience indirectly leading a global team
• 3+ years of experience developing and managing operational metrics
• 3+ years of experience working within a health plan and/or managed care business operation

Preferred Qualifications:

• Certified Coder or RN/LPN
• 1+ years in leadership role with experience in management of supervisors and leaders
• 1+ year experience during new client implementation
• Experience in fraud detection, analytic methodologies, payment policies and provider contracts
• Proven ability to produce superior results in a financial performance-oriented environment
• Solid leadership and strategic planning skills within a matrix environment
• Excellent communication, presentation and negotiation skills
• Solid interpersonal skills, ability to work with all levels of management across all functional areas

*All employees working remotely will berequiredto 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 $112,700 - $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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 help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are 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 and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.