You'll join a high caliber team where you're assisting, educating, problem-solving and resolving tenuous situations to the best possible outcomes. Bring your people skills, emotional strength and attention to detail. In return we offer the latest tools and most intensive training program in the industry. Get ready to start doing your life's best work.(sm) Payment Integrity - High Dollar Audit Team audits claims on a prospective basis. You will contribute to the reduction of the Affordability Gap. Claims with a high value payment amount are selected for audit with a focus on the accuracy of paid dollar amount. Positions in this function are responsible for end to end business process activities and all related aspects of claim system processes and claim business rules. Candidates will diagnose process improvement opportunities and develop strategic solutions using principles of operational excellence and related tools. This position is also responsible for reporting, analysis, planning, and programs to support continuous improvement of the high dollar audit value stream. Primary Responsibilities:Assess and interpret each segments needs and requirements Solve complex problems and/or conduct complex analysis Effectively manage a team to exceed all Operational and Financial Targets Work with minimal guidance; seek guidance on only the most complex tasks Translate concepts into practice Coach, provide feedback and guide others Providing guidance and oversight to other value streams and business partners who provide services for Payment Integrity Operations Identify additional medical cost savings opportunities and ensure we are following all CMS and Internal guidelines Providing frequent updates on team targets and departmental objectives to Senior Leadership Functional SME Resource to senior leadership Provide leadership to and is accountable for the performance of managers and or senior level professional staff Develop functional strategy, plans, production and or organizational priorities Identify and resolves operational, organizational and technical problems Identify risks and opportunities associated with current process
Required Qualifications:Bachelor's degree in Business, Statistics, Computer Science, Accounting, Medical or a related field Significant experience in the healthcare insurance industry, preferably in claims and/or audit/recovery role Strong experience performing financial analysis, reporting and building knowledge of statistical calculation and interpretation Demonstrated management experience with the ability to lead a team to achieve financial targets and goals Advanced knowledge of Microsoft Excel and Microsoft office suite Ability to identify and understand the data needs of a growing organization Strong analytical thinking with the ability to make well informed decisions Strong verbal and written communication skills Strong interpersonal skills and ability to interact with multiple departments and management Ability to multitask and meet critical deadlines Ability to demonstrate thought leadership Demonstrate the ability to develop and continuously improve, upstream and downstream impacts to our business partners Proven experience with change management and strategic thinkingPreferred Qualifications:Experience with claims processing systems such as COSMOS, NICE, Facets, UNET Advanced Knowledge of Microsoft Access Experience with HDTV inventory management tool US healthcare experience Technology Careers with Optum. Information and technology have amazing power to transform the health care industry and improve people's lives. This is where it's happening. This is where you'll help solve the problems that have never been solved. We're freeing information so it can be used safely and securely wherever it's needed. We're creating the very best ideas that can most easily be put into action to help our clients improve the quality of care and lower costs for millions. This is where the best and the brightest work together to make positive change a reality. This is the place to do your life's best work.(sm) 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. Job Keywords: Director, Management, Audits, High Dollar Audits, Medicare, Claims, Dublin, Ireland
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.