Operations Manager - Medical Claims Payer Experience Required (Las Vegas, Atlanta)

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)

The Claims Operations Manager is responsible for management and administration of multiple functions, or management of general business operations within Optum Medical Network (OMN) Claims Department.

Primary Responsibilities:

• Oversee daily operations of multiple levels of staff and multiple functions across one or more business units


• Manage day to day site operations, supervisor leadership (internal and external to organization), and accountability for financial and non-financial results (budgets and actuals)


• Provide expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims


• Authorize the appropriate payment or refers claims to investigators for further review


• Conduct data entry and re-work; analyzes and identifies trends and provides reports as necessary


• Lead project management and implementation initiatives

Position will manage several functions within OMN. Those functions are Medical Claim Review, COB/Subrogation and Issue Resolution (claims adjustments). Person selected must be comfortable managing multiple functions with very small staff.

Required Qualifications:

• High school diploma or GED


• 3+ years supervisory/managerial experience in medical claims adjudication for a payer and customer service


• 2+ years managing relationships with clients and/or vendors


• 2+ years managing budgets, process improvement and quality assurance


• Intermediate Microsoft Office skills

Preferred Qualifications:

• Undergraduate degree or higher


• Understanding of claims processing systems from a payer's perspective
  


• 5+ years of healthcare claims leadership experience


• 2+ years of experience developing presentations to include charting


• Senior Level Supervisory/Managerial experience in medical claims

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system 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)