The job below is no longer available.

You might also like

in La Palma, CA

Use left and right arrow keys to navigate
Hours Full-time, Part-time
Location LA PALMA, CA
LA PALMA, California

About this job

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)Primary Responsibilities:

Responsible for the oversight of the claims department and directs and monitor department work flow
Generate reports and perform claims analysis to monitor the claims operations
Generate monthly/quarterly health plan compliance reports
Oversee and monitor the claims process including the claims denial and dispute process
Assists in developing and implementing claims operations policies and procedures
Oversee the preparation of claims on-site health plan audits and assists in developing and implementing corrective action plan if required
Participate on-site meetings with internal and external customers
Rresolve claim issues with internal and external customers
Perform other duties as directed
Promote and contribute to a fair, positive and professional work environment through both management style and personal example
Identify problems that may cause claims non-compliance

Requirements


Required Qualifications: 

Extensive and specialized knowledge of claims operations as is generally acquired by 5+ years claims management experience in a managed care environment
Formal or informal leadership experience
Excellent written and verbal communication skills
Experience in working with providers
Problem solving and independent critical thinking skills
Good computer skills
Position Performance Criteria: 

Technical - strong knowledge in claims operation, claims system and general knowledge of regulatory requirements as it pertains to claims processing, timely and accurate payment requirements
Communication skills - communicates clearly, professionally, and respectfully to peers, superiors, subordinates and customers
Reliability - demonstrates responsibility through a positive attendance record and punctuality
Organization skills - ability to organize work assignments and work independently prioritizing task assigned
Work quality - consistently produces high quality work product, demonstrates a clear understanding of the functions of the department
Productivity - ability to meet deadlines and complete tasks assigned in a timely and efficient manner
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) 
  
  
AppleCare Medical Management Group was incorporated in 2003. Over the last 17 years, the multispecialty medical group of independent practices has expanded into new communities, contracted with more hospitals and health plans, and added over 50 new doctors - but the mission has remained the same. Today, AppleCare Medical Management is comprised of hundreds of board-certified private-practice, independent physicians. Collectively, our physicians have been serving the Southeast area of Los Angeles and Northern Orange County for decades, providing their medical expertise and passion to improving the health of our communities. 
  
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 Manager