Out of Network Operations Leader / Program Inquiry Team - Telecommute
March 14, 2018
Green Bay, Wisconsin
Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm) The Program Inquiry team in Out Of Network Operations handles non-written inquiries from providers, members, groups, and OON Program Managers via internal sources. Work is also received from our OON Vendors via email. Inquires include pricing disputes, balance billing of the member, successful negotiations from the vendor and request for adjustments due to review of contracts or system issues.In this position you will be responsible for the successful management of a direct report operational team. This includes responsibility for the coaching and mentoring of staff including production and quality goals. This role also includes working with the OON Training and Quality staff to set up training for new hires and reviewing quality audits. You will work with your peer leaders to maintain turnaround times in the OON Operations area and deploy staff where needed. This position will work in collaboration with OON Program Managers, OON program leadership and OON Trainer on the roll out of Affordability projects and OON program changes. This position also performs research on escalated requests from management and other duties and projects as assigned.Primary Responsibilities: Coach and mentor operation staff by reviewing production goals and responding to Quality auditsConduct monthly 1x1's with direct staffWork with Quality and Training staff to update changes to SOP's and any additional training needsWork with Program managers to implement changes to procedures due to roll out of OON program changes or new programs Manage inventory and TAT and work with peer leaders to deploy staff where neededResearch and report findings on escalated issues as requested by management or the legal departmentWork with external vendors on OON Operational issues that may arise and roll out of any program changes that may affect flow of work between OON and external vendorReview OON program metrics on a monthly basis including but not limited to savings reporting, adoption reporting, SSP web reporting and issue/project dashboard etc.Work with OON Support staff to ensure that inventory tracking, reports and OON Scorecards are accurate and review and resolve outlier data
Required Qualifications:5+ years of claims processing and adjustment experience5+ years knowledge of or experience in member or provider services and reworkStrong research and analytical skillsIntermediate proficiency in MS Word and ExcelExcellent written and verbal communication skillsAbility to work with minimal directionAbility to collaborate with the OON Trainer on training materials and P&P updatesAbility to collaborate with the OON Quality area on disputes and changes to quality programAbility to convey complex information to others and make it more easily understoodAbility to prioritize multiple tasks in an environment of rapid change4+ years of leadership experience leading a team of direct reports in a production role 4+ years of Subject Matter Experience in OON programs Preferred qualifications:Understanding of OON programs, claim handling from initial pricing to disputes and appeals 5+ years system experience with Unet, NDB, ORS, Pulse, UHOPS, Rumba, Facets, NICE or other claims processing and support systemsWebstrat application experiencePowerPoint proficiencyCareers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.SMYou'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. 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.
Internal Number: 752311
About UnitedHealth Group
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.