No industry is moving faster than health care. And no organization is better positioned to lead health care forward. We need attention to every detail with an eye for the points no one has considered. You'll help improve the health of millions. And you'll do your life's best work.(sm) Community and State Claim Operations is a core UnitedHealthcare Benefit Operations division. Providing exceptional service and meeting the needs of our constituents is integral to the success and growth of the UnitedHealthcare Community & State business segment. The Vice President of Claims will be responsible for developing and executing divisional strategies and objectives that support the company's mission and goals for continued profitability and membership growth. This person will provide strategic direction for the administration and adjudication of Medicaid claims processing for the Community & State market segment. This includes outward facing responsibilities for claim operations to the customer segments, Health plan and other supporting organizations representing claim operations. The Vice President of Claims will champion improvements of the care provider experience as it relates to End to End Claim Operations including first and second pass claim adjudication. This position is critical to maintaining a direct line of accountability, communication and assurance to the customer segment and responsible for key operations teams of 1000+ employees. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities:Effective management of production areas within claim operations, delivering accurate, timely and efficient service to members and providers Responsible for driving the leadership cornerstones of redefining quality, aligning accountability and enabling people Determine, provide leadership to and be accountable for the performance and results through multiple layers of management and staff Define and develop strategies and tools needed to optimize and measure performance to ensure consistent achievement of business objectives Provide expertise to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims Consistently demonstrates ability to succeed in a continuously changing and challenging environment Develop innovative operational solutions and implement successfully to deliver results including automationDevelop customer centric culture for a superior service experience Lead large scale initiatives and drive change throughout the organization Leverage analytical skills to identify trends / opportunities and present clear communications to all levels of the organization Communicate and collaborate effectively within matrix environment Operate effectively as the external representative of Claim Operations to clients through external audit remediation, client meetings and external new business sales activities Participates with senior management to develop, modify and implement the strategic direction of the companyServes as the primary contact with the health plans and business partners on the implementation of new or expanding businessOversees the operational aspects of new product implementations to ensure operational contract complianceOversees the operational aspects of new site start-ups to support in state requirements for new or expanding businessDelivers executive level presentations and summaries, driving corrective actions based on operational results and develops/enhances business policy to align with regulatory programs
Required Qualifications: Bachelor's degree required 15+ years of increasingly responsible operations leadership experience, preferably in the health insurance industry or another highly regulated industry, required7+ years' experience senior level operational leadership, leading and managing large scale, operations5+ years of experience leading and driving large scale team performance of at least 500+ employees, 5+ years of experience with strategic, consumer-centric initiative development and implementation, including operating policies and procedures, and work process improvements Demonstrated success at driving high employee engagement and lowering attritionStrong analytical skills with ability to drive transformational, consumer-centric change and manage long-term programs requiredDemonstrated results with simplifying, automating and innovating complex processesStrong verbal, written, interpersonal and presentation skills required. The proven ability to collaborate and influence internal and external business partners is essentialA proven track of building and fostering relationships at all levels of the organization requiredDemonstrated ability to lead and develop leaders, requiredExperience working in a highly regulated industry preferredStrong operational focus with demonstrated project management, change management, and execution skillsSelf-motivated and able to work with little direct supervision and drive results with disciplined follow-thoughStrong strategic thinking and business acumen with the ability to align people related strategies and recommendations with business objectivesHigh integrity with a reputation of a trusted confidential adviser and partnerStrong decision making skills including prioritization of capital investments and business change controlsSuperior executive presence and ability to communicate effectively to the highest levels of leadership10-15% travel requiredPreferred Qualifications:Master's DegreeMedical Claims experience strongly preferred Deep understanding of healthcare operations and regulatory expectations of state Medicaid agencies and programs as well as CMSMedicaid, Medicare, Long Term Care and/or government health plan experience a plusRegulatory experience a plusCareers 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.(sm)*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy For more information on our Internal Job Posting Policy, click here. 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: VP Healthcare Claims" "Healthcare Claims Leader, Minnetonka, MN, Minnesota, telecommute
Internal Number: 759759
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.