Claims Manager - La Palma, CA - Full-time / Part-time

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 weekly claims check runs

Oversee and monitor the claims internal audits

Oversee and monitor the claims process including claims adjudication, denial and dispute process

Assists in developing and implementing claims operations policies and procedures

Participate in on-site meetings with internal and external customers

Resolve 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

Required Qualifications:


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

5 years of experience in claims operations in a managed care setting that includes managing personnel in a claims processing environment

Familiar with regulatory and reporting standards with DMHC, AB 1455, and CMS requiremetns

Strong working experience with provider reimbursement methodologies

High school diploma
 
Preferred Qualifications:


Degree in Healthcare, Business, Administration or related field
 
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)
 
 
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.