The primary role of the Manager General Management is to lead a team of employees assigned to accomplish the adjudication of all claims within an assigned client, including contract/duplicate claims and coordination of benefit claims. The team members may include: COB Claims Analysts, Contracts and Duplicates Claims Analysts, and Production Team Analysts.
The Manager General Management is responsible for selecting, coaching and continuously motivating team members to achieve high levels of performance. The tools the Manager General Management has at hand to measure performance of team members and corresponding client goals include: quality assurance, production reports and statistical data. By using these tools the Manager General Management can successfully address concerns such as: appropriate staffing levels, accurate claims/production, goal(s) alignment, succession planning.
The Manager General Management must maintain a strong working relationship with the corresponding Client Manager in order to ensure a successful partnership for the client and ensure that the Production Team is aware of client mandates, performance and quality standards and any changes to the work accomplished on behalf of the client.
The Manager General Management works collaboratively with Data Analysts to determine priority of inventory. Together, they help assess the quality of inventory to be worked and evaluate the feedback from the Claims Analysts in order to assist the Data Analysts in identifying trends and writing queries.
The Manager General Management works collaboratively with the Business Excellence department in order to uphold best practices, indentify process improvements and maintain (increase) quality and production levels, and indentify and answer all training needs.
Essential Job Functions
Supervision of Claims Analysts â€“ Work with Claims Analysts to ensure they understand production and quality expectations. Manage production for each analyst on a daily basis, providing feedback and coaching in order to help the employee achieve their goal (and thereby reach team goal). When an analyst is having difficulty, Manager takes time to offer feedback, coaching and requests assistance and guidance from others in order to determine appropriate action which may include: further formal training, assistance from floor trainer, a formal performance improvement plan, and/or the commencement of disciplinary action up and including disciplinary action. Works assignment given and works queue assigned as established on a daily basis.
Production â€“ Work with, Claims Analysts, QC Specialists and Data Analysts in order to maximize quality identification. Work with Claims Analysts to ensure they have all necessary tools and information in order to find overpayments. Consistently evaluate processes and procedures for Analysts and recommend changes that would increase Claims Analystsâ€™ production.
Production Standard Operating Procedures (SOPâ€™s) - The Manager General Management must have a complete understanding of the targeted trend for each production query in Claim Miner. The position is responsible for establishing and ensuring documentation and communication of all query SOPâ€™s associated with the client.
Reporting â€“ Utilization and understanding of Claim Miner system and reports used to manage and prioritize production inventory. The Manager General Management must be able to explain system and productions trends proficiently and accurately to upper management. Work with, QC Specialist, Data Analyst, and Provider AR Specialist reporting to maximize quality and process efficiencies.
Collaboration with Other Teams â€“ The Manager General Management must work collaboratively and at various levels throughout the organization in order to ensure their team is able to meet its goals. The ability to communicate effectively with these teams (ex: Business Excellence, MDMO, Data Analyst, Client Manager, etc) and act upon the feedback given is absolutely vital to the teamâ€™s success. Communication with the Client Manager is vital in order to ensure that Analysts are kept informed of all client needs and changes. Further, the Client Manager gives feedback to the Manager General Management in relation to team quality and individual team member quality. It is important for the both individuals to give and receive feedback; from the standpoint of the Manager General Management, his/her team must be able to achieve the quality and productivity expectations of the client. The Client Manager may be able to help pinpoint areas that will help the production team reach that standard. The Data Analyst is a key position to the Production Team; again, it is vital that the Data Analyst understand the client and be able to give/receive feedback from the Manager General Management in order to write queries and define trends.
3+ years health care experience
1+ medical claims payment or health care auditing experience is required
Prior experience in a lead or manager role
Medical claims data mining preferred
Previous knowledge of payersâ€™ medical claims payment systems is preferred.
Previous medical claims auditing experience preferred.
Bachelors degee preferred
Demonstrates competency in use of Word and Excel software.
Demonstrates effective organizational skills.
Able to present ideas/goals in business-friendly and user-friendly language.
Quickly and effectively adapts to change.
Demonstrates excellent written and oral communication skills.
Possesses keen attention to detail.
Utilizes analytical and problem-solving skills.
Able to handle multiple tasks.
OptumInsight is one of the largest and fastest growing health information companies. We specialize in improving the performance of the health system by providing analytics, technology and consulting services that enable better decisions and results. We integrate workflow solutions that deliver data in real-time, and create actionable insights - processing health information that relates directly to and affects one in four patients in the U.S, one in every three Medicaid dollars and one in every five emergency room visits. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.
What can YOU do with the right information? At OptumInsight, the possibilities and the impact are limitless. No matter what your role is at OptumInsight, you'll be empowered to ask more questions, develop better solutions and help make the health care system greater than ever. It's always fresh. It's always exciting. And it's never been more important.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
UnitedHealth Group - 13 months ago
When you work to better people’s lives, one of those lives will always be yours.
We have modest goals: Improve the lives of...