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The Manager Claims / OperationsManager is responsible for overall leadership and managing the internalfunctions of team while promoting high levels of quality production andexcellent customer service. Facilitates necessary training of procedures/ processes and acts as a technical expert. May also manage one or morespecialized operational function(s) such as adjustments, over payments andrecovery.
Provide customer service.
Ensure procedures related to above processes produce accurate, timely, and consistent results.
Review on a regular basis, team and individual production and quality of customer service and claim adjudication. The review process includes:Analyzing production figures, monitoring pends/holds and daily work reports, overpayment follow-up, determining the effectiveness of work flow within team.
The Operations Manager will follow up with team and individual team members to establish and clarify goals in these areas to ensure that high production and quality standards are met.
The Operations Manager ls responsible for facilitating training and mentoring (as necessary) to attain goals.
Motivate team members to maintain targeted claims turnaround time that integrates with company-wide goals and TML including auto adjudication rates.
Act as Project Leader in the review of new processes and efficiency of existing internal processes with goal of improving and streamlining all UMR's processes. This includes interfacing with all supporting
Areas/departments within UMR and TML.
Serve on procedural review with UMR's internal group and TML, which reviews and establishes procedures for the entire company.
Partner with other departments within UMR to expedite and improve timeliness of workflow.
Interview potential new team members and provide feedback to 1he Director regarding hiring of new team members.
Identifies and facilitates team and individual support and training needs.
Make recommendations to Director regarding promotion of team members.
Responsible for counseling needs of individual team members, facilitates termination, and provides documentation supporting...
Facilitates annual performance evaluations of team members.
Review effectiveness of assigned mentors and the mentoring process. The Operations Manager is a mentor to team members.
Complete time sheets and approve and monitor PTO, making sure that the team is adequately staffed to provide superior levels of service.
Partner with Quality Assurance Department in preparation of team quality assurance reviews. Ensure prompt response. Review and analyze audit results and trends, and shares results with team and individual team members.
Attend regularly scheduled Team Leader meetings to discuss processing issues and develop consistent procedures company wide.
Act on behalf of the director in his/her absence. Responsible for addressing immediate customer concerns/complaint via phone, letter,
Email, or in person at the office.
Review high dollar claims and complex written communication from team members.
Assign and re-assign customer workload when associates are hired, resign, or new customers are added to the team.
Report team's performance to appropriate contact for purposes of calculating performance bonuses.
Update associate information on the Internet or through email to the appropriate internal contact
Communicate with the External Account Manager to ensure timely and accurate communication of customer changes.
Effectively facilitates regularly scheduled team meetings.
Associate Degree (or higher) or High School Diploma / GED with 2 years of Claimsexperience
Extensive knowledge of and experience in the application ofclaim processes, procedures, and philosophies
Bachelor's degree or higher.
Knowledge of Texas laws and NCQA a plus
Knowledge of CPS claim processing and reporting.
Understanding of stop loss insurance and reporting I-filingprocess
Successful completion of management and leadership
Experience in a role requiring understanding of thesignificance of the customer relationship and having a desire to constantlyenhance that relationship
Experience in a role requiring proven advanced organizationalskills and ability to prioritize work.
Advanced problem-solving skills including ability toreview at detailed level
Interpersonal skills - counseling & mentoring others
Ability to handle difficult situations
Basic problem-solving skills
Decision making skills
Basic organization skills
Strong customer focus and sense of urgency
Ability to manage a variety of activities at the same time
Careers at UnitedHealthcare Employer& Individual. We all want to make a differencewith the work we do. Sometimes we're presented with an opportunity to make adifference on a scale we couldn't imagine. Here, you get that opportunity everyday. As a member of one of our elite teams, you'll provide the ideas andsolutions that help nearly 25 million customers live healthier lives. You'llhelp write the next chapter in the history of health care. And you'll find awealth of open doors and career paths that will take you as far as you want togo. Go further. This is your life's best work.SM
Diversity creates a healthier atmosphere: UnitedHealth Group is an EqualEmployment Opportunity/Affirmative Action employer and all qualified applicantswill receive consideration for employment without regard to race, color,religion, sex, age, national origin, protected veteran status, disabilitystatus, 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 adrug test before beginning employment.
Keywords: UnitedHealth Group, TML, SIU, Operations Manager, Claims, Austin
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