Claims Operations Manager

This position follows a hybrid schedule with (4) In-office days per week. Our office is located at 115 W. Washington St., Indianapolis, Indiana 46204. 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 optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together . 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 As the Claims Manager, you'll help identify and overcome errors in claims processing while ensuring adherence to compliance policies. The Claims Manager is responsible for oversight of management and administration of multiple areas that impact benefit configuration and/or claims functions. As you take on this task, you'll be responsible for ensuring prompt and accurate provider claims processing in accordance with state requirements. This individual shall work in collaboration with the CIO and Data Director to ensure the timely and accurate submission of encounter data. Handles interactions with providers and claims management staff regarding provider claims inquiries or requests for assistance with claims issues, including working on end-to-end provider claim and call quality, ease of use of physician portal and future service enhancements, and training and development of external provider education programs regarding claims submission processes. 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. It may be necessary, given the business need, to work occasional overtime. Our office is located at 115 W. Washington St., Indianapolis, IN 46204. This role follows a hybrid work arrangement, with some in-office days required. The specific onsite schedule will be determined based on business needs and communicated by leadership.

Analyze metrics and trends to proactively identify gaps in claims adjudication - working with matrix partners to improve performance and present potential alternative solutions as appropriate Provides subject matter expertise on claims adjudication and benefit configuration inquiries Oversees end-to-end adjudication of claims Coordinates, leads, and completes projects across various functional areas Navigate a challenging matrix environment, lead multi-faceted and multi-functional teams with a strong ability to problem solve and lead and motivate others in problem resolution Identify opportunities for innovation, productivity improvement and savings Will work directly with health plan leadership and claims/benefit leadership as your drive changes and improvements to the process. Creates clear and concise written and oral communication, including presentations to management, that details project status, risks, issues, scope and timeline Ensures projects are completed on time and in scope. Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance Provide expertise or general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims Leads operational strategy to reduce costs while improving customer experience Lead project management and implementation initiatives Adheres to applicable policies and procedures regarding claims adjudication (e.g., reimbursement; claims; appeals; credentialing; complaints; medical policies; benefits design; regulatory requirements; client business rules. Stays current on industry-related trends and/or events