Claims Director - Sacramento or Rancho Cordova, CA
January 10, 2018
You'll join a high caliber team where you're assisting, educating, problem-solving and resolving tenuous situations to the best possible outcomes. Bring your people skills, emotional strength and attention to detail. In return we offer the latest tools and most intensive training program in the industry. Get ready to start doing your life's best work.(sm) This is a Medicaid Leadership opportunity in California with a proposal to support large scale projects aligned to the effective and efficient delivery of services centered on payment of fee-for-service claims, provider and member relations, drug rebate, pharmacy operations support as well as other related services necessary to support the health care delivery. Candidates must be comfortable pursuing a permanent role that is contingent on future award status with client"The Claims Director is responsible for management and administration of multiple functions, or management of general business operations within Claims Department. Positions in this function are responsible for providing expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims. Authorizes the appropriate payment or refers claims to investigators for further review. Conducts data entry and re-work; analyzes and identifies trends and provides reports as necessary. Primary Responsibilities: Research, identify and obtain data / information needed to help process claims or resolve claims issues (e.g., verify pricing, prior authorizations, applicable benefits)Ensure that proper benefits are applied to every claimClient-facing interaction with the stateApply knowledge of customer service requirements to process claims appropriately (e.g., Service Level Agreements, performance guarantees)Identify and apply knowledge of new plans / customers to process their claims appropriatelyIdentify and resolve claims processing errors / issues and trends, as needed (e.g., related to system configuration, network, eligibility, data accuracy, vendor-related, provider)Resolve or address new or unusual claims errors / issues as they arise, applying appropriate knowledge or prior experienceCommunicate and collaborate with external stakeholders (e.g., members, family members, providers, vendors) to resolve claims errors / issues, using clear, simple language to ensure understandingCollaborate with internal business partners to resolve claims errors / issues (e.g., Subject Matter Experts, Network Management, IT / systems staff, Compliance, vendor management teams, contract teams)Document and communicate status of claims / investigations to stakeholders as needed, adhering to reporting requirements (e.g., status letters / reports)Achieve applicable performance metrics (e.g., productivity, quality, TAT)Use appropriate systems / platforms / applications to process claimsNavigate systems tools and screens efficiently and effectively (e.g., keyboard skills, macros, shortcuts)Use appropriate documentation, reference materials and / or websites to ensure that claims are processed accurately and efficiently (e.g., policy / procedure manuals, knowledge libraries, bulletins, training materials, databases, SharePoint sites, data warehouses)
Required Qualifications:Bachelor's degree and 4 years of experience managing healthcare claims processing operations for a government or private sector health care payer or 8 years related work experience in lieu of degree.Supervisory/administrative experience in the execution and/or evaluation of program policies.Experience managing relationships with clients and / or vendors Management experience within claims processing operationsPreferred Qualifications:5+ years of healthcare claims leadership experience Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care 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.(sm) 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. Job Keywords: Claims Director, Sacramento, Rancho Cordova, CA, California
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.