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

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life’s best work. SM

Our claims operations, including our Encounter Operations Manager roles, are the focal point of handling information about services patients receive and the way those services get paid. It's complex, detailed work. It's fast paced challenge. It's a job that calls on you to be thoughtful, resourceful, team-driven and customer-focused. To put it mildly, there is never a dull moment.

This position Leads a team of senior consultants responsible for resolving escalated and systemic encounter data issues across all lines of business. This position will also focus on heavy proactive engagement and collaboration with our provider delegate partners to create, control, and improve the end-to-end business processes/transactions to ensure accurate, timely, and complete delegate encounter data. This role requires strong people leader skills, as well as solid technical subject matter expertise.

This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of (8:00am - 5:00pm).

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

• Leads a team of professional level SMEs (grade 27) supporting resolution of escalated encounter edit and other technical submission issues.
• Identifies and leads root cause analysis and resolution of systemic encounter error trends across multiple provider delegates.
• Oversees ongoing proactive engagement with the provider delegates to strengthen partnerships and to facilitate deep dive analytical review sessions to improve the End- to-End encounter submission process.
• Collaborates with key stakeholders and CapDel leaders, such as the Claims Delegate Oversight Team, for all claims processing issues identified via encounter reviews.
• Active SME engagement to support improvements to existing encounter data capabilities and to provide input to the large, complex initiative to implement the future state encounter data capabilities.
• End to end accountability for reducing encounter data errors and increasing the speed of resolution (50+ million transactions annually).
• Engages with ~100 providers risk entities to ensure timely and accurate submission of encounter data
• Accountable for achieving all defined performance and operational metrics for encounter data such as issue turnaround times, error rates, member cost share accuracy, and completeness percentages.
• Executes upon continual business process transformation to achieve operational efficiency and effectiveness goals as well as performance metrics.
• Oversees senior consultant performance, provides constructive feedback and coaching, and identifies development needs
• Communicates effectively to translate highly technical and complex encounter concepts in ways that can be understood by a variety of audiences.
• Sets team direction, resolves problems, and provides guidance to members of team and acts as a resource and mentor to other teams.
• Ensure appropriate end to end controls and monitoring of member cost share and encounter transactions
• Work with UHN business partners to align the provider contracts and update the provider administration guide related to the requirements for the submission of encounters and member cost share administration
• Develops expert level encounter transaction knowledge that includes HIPAA 837 requirements, as well as the various encounter edit and rejection reasons across the entire end-to-end process from the External Clearinghouse to Optum Insight to the various front-end applications and claims platforms.
• Serves as a thought leader for encounters and vigorously engages in the future state development of encounters. This includes defining standard operational policies and business processes to accompany the technology capability across all lines of business (>50 million annual transactions) and multiple teams. It also includes approving business requirements and proposed technical capability solutions.
• Mentors and trains other encounter team members and encounter personnel at the many provider delegates.
• Actively engages with the provider delegates (~100 provider risk entities) to offer expertise, guidance, and consulting to improve the quality of the end-to-end encounter submission process.
• Independently identifies and leads large complex projects to achieve operational efficiency and effectiveness as well as performance metrics and key business objectives.
• Leads the achievement of all defined performance and operational metrics for encounter data such as issue turnaround times, error rates, member cost share accuracy, and completeness percentages.
• Develops and executes encounter strategy across all lines of business and ensures that the risk-based capabilities and related processes under development support a consistent provider experience across the multiple encounter platforms and are compliant with all federal and state regulations. Develops and manages business plans to achieve objectives.
• Leverages technical expertise to support the resolution of escalated encounter edit and other technical submission issues and acts as a trainer and mentor to the Encounter Escalations team.
• Communicates effectively to translate highly technical and complex encounter concepts in ways that can be understood by a variety of audiences, including senior line of business and health plan leaders.
• Creates documented technical guidance for the provider delegates to improve quality of encounter submissions.
• Provides expert support for the identification and resolution of the root cause for systemic encounter error trends across multiple provider delegates.
• Uses critical thinking skills to anticipate delegate needs & proactively develop solutions to meet them.
• Drives issues to closure independently.
• Creates urgency in resolving issues quickly and efficiently
• Ensure appropriate end to end controls and monitoring of member cost share and encounter transactions and drive implementation of process improvements where appropriate.
• Adaptable and capable of working in a fast-paced environment.
• Acts as a resource to senior leadership
• Develops pioneering approaches to emerging industry trends
• Predicts emerging customer needs and develops innovative solutions to meet them.

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:

• Bachelor’s Degree (or higher) OR High School Diploma / GED with 3+ years of equivalent experience
• 3+ years of experience leading operational teams with 5 or more direct reports
• 3+ years of experience using operational metrics, data/analytics, capacity planning, goals/objectives, and dashboards to run, interpret, and drive business performance
• 3+ years of experience working with regulatory compliance or quality adherence
• 3+ years of experience developing and implementing business process change initiatives, including documentation
• 3+ years of experience in communication, internal and external executive level
• 3+ years of experience in a Progressive leadership positions with a focus on business operations and advisory positions
• Advanced experience in MS Office such as Excel (Create, Pivot, Formulas, vlookups etc.); PowerPoint (Create, save, and present presentations)
• Ability to work an 8-hour shift Monday-Friday from 8:00am to 5:00pm

Preferred Qualifications:

• Master's Degree (or higher)
• Experience in the Health Care industry
• Knowledge of Value Based Contracting or Capitated Delegated Division of Responsibility business models
• Solid understanding of business functions (HR, finance etc.)
• Black Belt or similar ability to design new processes
• Change Management experience

Telecommuting Requirements:

• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Ability to keep all company sensitive documents secure (if applicable)
• 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:

• Highly efficient with relationship skills
• High proficiency presenting (verbal and written) complex operational information

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.

At UnitedHealthcare , we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life’s best work. SM

Colorado, Connecticut, Nevada or New York City Residents Only: The salary range for Colorado residents is $82,100 - $146,900. The salary range for Connecticut / Nevada / New York City residents is $90,500 - $161,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies required all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

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.

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