Associate Director of Claims - Telecommute

Careers at UnitedHealth Group

We're creating opportunities in every corner of the health care marketplace to improve lives while we're building careers. At UnitedHealth Group, we support you with the latest tools, advanced training and the combined strength of high caliber co-workers who share your passion, your energy and your commitment to quality. Join us and start doing your life's best work. SM


Compassion. It's the starting point for health care providers like you and it's what drives us every day as we put our exceptional skills together with a real feeling of caring for others. This is a place where your impact goes beyond providing care one patient at a time. Because here, every day, you're also providing leadership and contributing in ways that can affect millions for years to come. Ready for a new path? Learn more, and start doing your life's best work. SM

Our teams are helping people from around the world. We can bring out your best as you put your listening, analytical and problem solving skills to work in a setting that is geared to helping improve lives and enhance health care for millions. Here, you'll discover a wealth of pathways for professional growth within Customer Service, Billing, Claims, Enrollment & Eligibility and across our global economy. Join us and find out why this is the place to do your life's best work. SM

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

The Director of Claims is responsible for claims processing operations to meet State, Federal, and applicable accreditation standards for the claims functions of MCNA Dental Plans or any claims delegated entity. Director of Claims establishes, implements, and performs claim auditing functions and oversight. The Director shall set objectives and priorities and coordinate work activities, functions, and projects to meet goals and objectives. Participates in the QIC, and reports claims quality indicators to the QMC. Additionally, the Director of Claims provides reports, analysis, and corrective action plans. Create, implement department standard for both quality and quantity of claims.

You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:
  • Establish, develop, and implement standard health care organization claims functions such as: Auditing, production cycles, accuracy, timeliness, quality checks for accuracy rates systems, production goals, and other standard operations for claims
  • Provide for: COB, Subrogation and Re-Insurance strategies to maximize recoveries
  • Develops and implements management reports to track the financial and procedural accuracy and timeliness of claims processing
  • Evaluates claims processing systems, manual and automatic, to identify areas for development; implements changes as necessary
  • Ensures compliance of plan or claims entity with current and any updated AHCA, DFS, HHSC or CMS guidelines
  • Provides for financial reports, claims paid, and other adjudication processes
  • Participates on the QIC committee
  • Develops department staffing and budget needs
  • Planning and forecasting for short and long-range objectives
  • Develops meetings to report activities and develop actions
  • Conducts system and process trainings

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:
  • Bachelor's degree or equivalent experience
  • 7+ years of experience in a claims department
  • 5+ years of experience as claims manager for insurance/health care company

Preferred Qualifications:
  • 3+ years of experience as a Supervisor of professional exempt and of non-professional non-exempt personnelBroad claims and authorization experience at multiple levels, of the industry, from front entry level through managerial in claims, provider relations, cost containment, and quality control coordination of benefits/subrogation, customer service
  • In-depth knowledge of claims processing procedures, guidelines and support functions
  • Working knowledge of medical/dental terminology, diagnosis and procedure codes and their reference manuals
  • Ability to interview, hire, educate, annual evaluations, terminate
  • Ability to delegate functions
  • Demonstrated proficiency with software and systems, reports
  • Microsoft Office suite
  • Photocopier, Fax machine, Calculator
  • Ability to continually analyze statistical data
  • Superior organizational, analytical, and problem-solving skills
  • Excellent organizational, communication, operational skills
  • Excellent written and verbal communication skills
  • Supervises personnel

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we're presented with an opportunity to make a difference on a scale we couldn't imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you'll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You'll help write the next chapter in the history of health care. And you'll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is your life's best work.(sm)

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado, Connecticut and/or Nevada residents is $94,500 to $171,700. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

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.

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