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Director of Appeals & Grievances

UnitedHealth Group

Minnetonka, MN
Job Code:
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Job Details

Director of Appeals & Grievances(Job Number:714647)

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)

Primary Responsibilities:

This position is responsible for leading and directing an appeals and grievances operations team of 400 employees to ensure delivery of our contractual regulatory commitments for the UHC Community & State Health plans and to ensure members get the care and services that are needed to help them improve their health and overall quality of life.  Acts as the primary point of contact for UHC Community & State Healthplans for new business implementation, regulatory contract requirements and critical issue resolution as it relates to Appeals & Grievances. This position also serves as a key advocate to minimize friction in the most important relationship in health care, which is between the member and provider.  Manages and drives activities related to the UHC Community & State Grievance & Appeals functions for health plans, ensuring operational contract compliance as defined by the state contract. Finally this position is responsible for simplifying, automating and innovating Appeals & Grievance processes.

  • Exceed State Expectations
  • Creates a culture of advocating for the member & provider which supports Net Promoter Score and improves the overall experience with UHC
  • Effectively implement solutions that, simplify, automate and innovate with Appeals & Grievances
  • Ensure the right talent is in place to transform the member / provider experience and regulator perception related to Appeals & Grievances
  • Works closely with the UHC Operations business partners, United Clinical Services (UCS), Network and cross functional teams to accomplish organizational goals
  • Act as the end-to-end owner, responsible for operational management, meeting our commitments, strategy development and 3-year roadmap and enhancing our capabilities in Appeals & Grievances
  • Develop systems, processes and execute plans to continuously improve existing performance and efficiency in operational processes, specifically around cost, quality, timeliness and satisfaction
  • Leverage technology to improve speed to market delivery and increase cost savings
  • Serve as the end-to-end Grievance & Appeal subject matter expert and point of contact for the implementation of new health plans and products
  • Conducts gap analyses on non-compliant cases to understands reasons for not meeting state requirements, as well as developing action plans to address the issues/gaps with the cross functional teams
  • Represent UnitedHealth care Appeals and Grievances business process and results to State Regulators during audits and regulatory exams
  • Leads large, complex projects to achieve key business segment objectives
  • Develops systems and processes to monitor performance results and address gaps in performance
  • Delivers executive level presentations and summaries, driving corrective actions based on operational results and develops/enhances business policy to align with regulatory programs

Job Claims Appeals
Primary Location US-MN-Minnetonka
Other Location 
Organization C&S Ops Sr Mgmt
Schedule Full-time
Number of Openings 1
Apply on the Company Site

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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