E&I Quality Lead, Bus. Process & Quality Mgmt. - MN or Telecommute

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Provides strategic leadership for all operational quality functions (i.e., Call, Claims, Appeals, Billing & Enrollment, Print and Fulfillment, etc.), within BPQM Line of Business (LOB) (e.g., Employer and Individual).  Responsible for leading and implementing the overarching quality agenda for the BPQM Line of Business.
 
Primary Responsibilities:

Lead the development and implementation of the overarching quality agenda for the BPQM LOB. This includes implementing comprehensive constituent-driven programs that support the quality agenda for the UHC enterprise

Lead creation of quality programs across each functional work stream (i.e., Call, Claim, Appeals, Billing and Enrollment, Print and Fulfillment) to ensure key business controls are in place to mitigate risk and ensure operational outcomes are achieving zero defects
Lead development of statistical sampling methodology that ensures that the audit samples being pulled across work streams ensure results can be statically extrapolated across the audit universe based upon the findings
Partner with LOB leadership to understand the root cause of quality defects, evaluate impact to all stakeholders (i.e. customers, consumers and regulatory agencies) and innovative ways to remediate root cause findings
Identifies and evaluates the risk to business and quality outcomes related to new products, legislation, customers, platform migrations, and internal business process changes and ensures that all follow up remediation activities are monitored to ensure process changes are implemented and validate that the achieve the desired outcome and results
Collaborate with key internal and external business partners to stay abreast of changes internally or in the marketplace which impact BPQM LOB
Develop and maintain strong relationships built on trust, integrity, performance and objectivity, with senior business leaders and key stakeholders across UHG which influence upstream/downstream operational performance

Viewed as a strategic partner based upon the ability to synthesize and articulate root cause concerns, patterns, and trends; as well as engage leaders in a broader dialog on process redesign opportunities
Deliver high quality impactful reports which are clear, concise, identify root cause with a focus on remediation, and provide value to business partners and key stakeholders
Support the business in achieving their performance goals and metrics
Lead and develop a globally diverse and virtual organization of functional quality experts

Instill a quality mind-set through the dissemination of the "BPQM Approach to Quality" training which includes the development of quality methodology analytical skills
Create a work environment that sustains high employee engagement and retention.  Foster a culture of accountability
Govern overall quality of work performed through review, analysis, and taking action, when appropriate, to respond to key BPQM performance metric variances
Accountable for both financial and non-financial results and metrics, as well as leading short term and long-term capacity planning processes which are tied to the budget forecast
Creates, monitors, and takes appropriate action on Quality Scorecards (Claims, Call, Billing & Enrollment, Appeals, Print and Fulfillment) to ensure operational quality metrics are achieving targets
In partnership with VP LOB Leader, communicate and champion the BPQM vision, mission, and strategies in alignment with UHC’s goals and strategies
Lead the talent development process to ensure next generation of SME experts and leaders have development plans, are being developed and mentored with experiential opportunities to develop new skills; Focus on retention and succession planning development opportunities
Financial Responsibilities:

E&I - approximately $18M
Headcount Responsibilities:

E&I - approximately 290 on-shore; 200 off-shore

Required Qualifications:

Proven leadership with 10+ years of progressive operational leadership that involve complex back office systems and regulatory requirements (in a healthcare environment is a plus)
3+ years in a managerial capacity
Proven experience leading teams with layers of hierarchy within complex organizations
Proven experience building strong relationships with executive management and leadership teams, regulators, external auditors, and other key stakeholders built upon trust and credibility
Proven ability to influence without authority with all levels of leadership with proven conflict resolution skills
Excellent business and communication skills (written and verbal) with the ability to focus on the big picture, understand key priorities, influence others through clear, consistent, and high impact communications, and bring business acumen to leading the BPQM LOB function
Strong analytical and process skills, with the ability to articulate and define outcome measures that capture key performance metrics
Proven experience in navigating complex stakeholder relationships in a matrix environment, with politically sensitive concerns
Preferred Qualifications:

Knowledge of CMS operational processing guidelines and regulatory requirements
Careers 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)
 
 
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: operational leadership, healthcare, BPQM LOB, CMS, Minnetonka, MN, telecommute, remote, work from home