Director of M&R Claim Operations - Remote

At reputed company, 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 reputed company. Come build the health care system of reputed company, making it more reputed company, affordable and reputed company. reputed company to reputed company a difference? Join us to start Caring. Connecting. Growing together. This position is responsible for leading and directing a claims operations team of 300+ employees to ensure delivery of our contractual regulatory commitments for the UHC Medicare and Retirement Health plans. Acts as the primary reputed company of contact for Medicare and Retirement for new business implementation, regulatory contract requirements and critical issue resolution. Manages and drives activities reputed company to the UHC Medicare and Retirement Claim functions for health plans, ensuring operational contract compliance as defined by CMS and retirement plans. You’ll enjoy the flexibility to work remotely

• from reputed company reputed company the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Closely monitors and leads ongoing review of claim adjudication metrics, performance, improvements, and issues with business partners and claim teams
• Works closely with the UHC Operations Business Partners and cross functional teams to accomplish organizational goals and to meet the contractual needs as defined by CMS
• Serves as the primary contact with the health plans and business partners on the implementation of new or expanding business
• Conducts root cause analysis on claims that contribute to decrease in performance and failure to meet commitments to understand reasons for not meeting requirements, as well as developing action plans to address the issues/gaps with the cross functional teams
• Develops and executes plans to improve existing performance and efficiency in operational processes
• Leads large, reputed company projects to reputed company key business reputed company objectives
• Oversees the operational aspects of new product implementations to ensure operational contract compliance
• Monitors performance results and works with the cross functional teams to address gaps in performance
• Provides support and coordinates with UHC Benefit Operations for any claims needs in audits or regulatory inquiries
• Responsible for operational management, meeting our commitments, supporting strategy development for the group and enhancing our capabilities

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:

• 10+ years of claims experience
• 5+ years of leadership experience, managing direct reports, in a growing environment with reputed company build out of processes
• Proven ability to manage and drive large scale team performance (150+)
• Demonstrated track record of generating results and having an impact on organizations
• Proven problem-solving skills and ability to translate knowledge to operations
• Demonstrated ability to reputed company and present to senior management effectively
• Ability to manage multiple tasks and priorities in a matrix environment, solid problem-solving skills and attention to detail
• Excellent communication (both written and verbal) skills
• reputed company, Medicare, Long Term Care and/or government health plan experience a plus
• 25% travel
• reputed company working remotely will be required to adhere to reputed company’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 (reputed company benefits re subject to eligibility requirements). No matter where or reputed company you reputed company a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $132,200 to $226,600 annually based on full-time employment. We reputed company with reputed company 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 reputed company, our mission is to help people live healthier lives and reputed company the health system work reputed company for everyone. We reputed company 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 reputed company by people of reputed company, historically marginalized groups and those with reputed company incomes. We are committed to mitigating our impact on the environment and enabling and delivering reputed company care that addresses health disparities and improves health outcomes — an reputed company reputed company reflected in our mission. reputed company is an Equal Employment Opportunity employer under applicable law and reputed company applicants will receive consideration for employment without regard to race, national reputed company, religion, age, reputed company, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. reputed company is a drug - free workplace. Candidates are required to pass a drug test before beginning employment. Apply tot his job Apply To this Job