Claims Supervisor

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

As the Claims Supervisor you will be supervising claims processors 12+ and will oversee daily quality and inventory of claims for efficiency and accuracy to meet compliance. Claims that are being processed are claims that a member did not use their benefits for at pharmacy. You will also be tracking inventory, monitor active inventory to confirm claims are moving through the process that should be on average 5 claims per hour and will be assigned claims depending on the type of claim that are worked will be about 5 per hour. Any errors you will research to determine the error and work the claims processor to make correct to resubmit.

Claims Supervisor in this function will oversee daily claims inventory to ensure Medicare Part D timeliness compliance is maintained as well as appropriate turnaround time of claims processing for performance guarantees. The supervisor will provide expertise or general claims support to team in reviewing, researching, investigating processing claims. They will support short and long term operational/strategic business activities - by enhancing and maintaining operation information and models. They also develop and implement effective business solutions through research and analysis of data and claims/business processes.

This position is full time, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:30am - 5:00pm PST. It may be necessary, given the business need, to work occasional overtime.

We offer 4-6 weeks of on-the-job training. The hours of the training will be aligned with your schedule. Training will be conducted virtually from your home.

You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Conducts analysis, identifies trends, and provides direction to overall team.
• Daily oversight of Claims inventory
• Ensures that proper benefits are applied to every claim.
• Applies appropriate processes and procedures to process claims (e.g., claims processing policies and procedures, state mandates, CMS/Medicare guidelines, benefit plan directives).
• Manage audits, including training of team members.
• Manages claim(s) escalations. Resolve or address new or unusual claims errors/issues as they arise, applying appropriate knowledge or prior experience.
• Identifies/develops/implements new claims processes procedures/solutions as needed, and documents appropriately for future use (e.g., non-standard situations, special handling requirements).
• Identify training opportunities among staff members and implement training and operational synergies.
• Collaborate with internal or external business partners to resolve claims errors/issues along with operational partners to help improve claims processing workflows and efficiencies.
• Participates on strategic initiatives related to manual claim processing to knowledge share, test new processes, and ensures staff is trained to support.
• Conduct Team 1:1's and annual performance review

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School Diploma / GED OR equivalent years of work experience
• Must be 18 years of age OR older
• 1+ years of leadership and or subject matter expert
• 3+ years of PBM OR Healthplan experience
• Experience proficiency using Microsoft Word (create and / OR edit docs, sending correspondence), Excel (updating reports, spreadsheets, ability to create and / OR edit, basic formulas, sorting, filtering), PowerPoint (create and / OR edit presentations), Outlook (email, scheduling meetings)
• Ability to work full time, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:30am - 5:00pm PST. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications:

• Managing daily task of others (training, coaching, mentoring)
• Retail pharmacy experience.
• RxClaim system experience

Telecommuting Requirements:

• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

Soft Skills:

• Excellent customer service
• Ability to influence and negotiate through use of verbal, written, and interpersonal means with a diverse group of people/disciplines at all levels of an organization.
• Problem solving, propose, and implement solutions.
• Time management skills and ability to multi-task and prioritize work.
• Written and verbal communication skills
• Ability to work in a complex fast-paced environment, flexible and adaptable to changing situations, and a strong commitment to teamwork.
• Ability to remain calm in stressful situations and to always display professional conduct.

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $48,700 - $87,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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