Associate Director, Pre-Pay Claim Validation - Remote

Optum; Plymouth (MN); Remote; USD 113,000 - 193,000; Full time

Benefits offered by this job

Comprehensive benefits package

Incentive programs

Equity stock purchase plan

401k contribution

Job summary

Optum in the United States seeks an Associate Director to lead operational processes and delivery for pre-pay and post-pay claims review services across multiple Commercial clients. You will oversee 8-10 leaders and indirectly their teams, ensuring SLAs are met, capacity is managed, and continuous improvements reduce unit costs.

The role reports to senior leadership and involves coordinating with Client Associate Directors, Operations Managers, and matrix partners to standardize workflows and

Qualifications

• 5+ years of operational management experience with supervision of leaders.
• 3+ years of Fraud, Waste & Abuse space.
• 3+ years of workforce management and staffing.
• 3+ years of indirect global team leadership.
• 3+ years of client support and operational oversight.
• 3+ years of developing and managing operational metrics.
• 3+ years experience in health plan and/or managed care operations.

Responsibilities

• Provide direct leadership to 8-10 operational leaders and indirect oversight of their teams, setting clear expectations and driving accountability for operational results.
• Manage Inventory, SLAs, productivity, through capacity analysis planning and quality control.
• Lead readiness for large, multi-year contracts with coordination and quality assurance for services and continuous improvement.
• Identify and manage system issues, ensuring data integrity and security controls.
• Work with matrix partners to manage client obligations and deliverables.
• Achieve savings, revenue and IOI targets by staffing planning and identifying efficiency opportunities.
• Partner with R&D to drive policy expertise for better savings and revenue.
• Ensure adherence to state and federal compliance policies and contract requirements.
• Identify and remove barriers; conduct deep dive reviews for continuous improvement.
• Coordinate with offshore operations to deliver services at lower costs.

Skills

Operational leadership

Fraud, Waste, and Abuse domain

Workforce management

Global team leadership

Client relationship management

Operational metrics

Job description

Optum Insight is 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, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and 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 while Caring. Connecting. Growing together. The Associate Director will lead operational processes and delivery for pre-pay and post-pay claims review services supporting multiple Commercial clients, with direct oversight of 8-10 leaders and indirect oversight of their teams including indirect oversight and support for global operations. The role is accountable for meeting client service level agreements (SLAs), managing inventory and capacity, workforce modeling, maintaining quality, and improving productivity, efficiency, and process consistency. Responsibilities include setting operational expectations, managing performance, removing barriers, and leading projects and continuous improvement initiatives to strengthen execution and reduce unit costs. The Associate Director will partner with Client Associate Directors, Operations Managers, Team Leads, Clinical and Non-Clinical resources, Business Analysts, and Matrix Partners to standardize workflows, align resources, and meet contractual and regulatory requirements. The role retains accountability for financial and non-financial results, including budgets, SG&A cost goals, and approximately $1B in Commercial client savings through Fraud, Waste, and Error recoveries, while engaging regularly with clients and internal stakeholders to address operational priorities and sustain results.
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.

Primary Responsibilities

• Provide direct leadership to 8-10 operational leaders and indirect oversight of their teams, setting clear expectations and driving accountability for operational results
• Manage Inventory, SLAs, productivity, through capacity analysis planning and quality control
• As client growth and organizational demand dictates, ADs will also lead operational readiness 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
• 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; WFM) to identify resource requirements and/or create budgets and forecasts

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

• 5+ years operational management experience with experience in management of supervisors and leaders
• 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 client experience and ongoing operational support
• 3+ years 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 of 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
• Demonstrated solid leadership and strategic planning skills within a matrix environment
• Demonstrated excellent communication, presentation and negotiation skills
• Demonstrated solid interpersonal skills, ability to work with all levels of management across all functional areas
• 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 $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.