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Manager Business Process - San Antonio, TX

UnitedHealth Group

San Antonio, TX
Job Code:
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Job Details

745707 Manager Business Process San Antonio TX

Manager Business Process - San Antonio, TX (745707)

Position Description

Position Description:
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.

Positions in this function are responsible for all related aspects of claim system processes and claim business rules. Includes claims systems utilization, capacity analyses / planning and reporting. Includes claims-related business and systems analysis. Ensures data integrity, data security and process optimization.
Primary Responsibilities:
  • This position manages all aspects of planning, development, and delivery of the Strategic Operations Support (SOS) team’s core goals and supervises the SOS team
  • Develops new processes / procedures for UHC STARS initiatives, as it relates to the provider inquiry mailbox
  • Assists the UHC ACE team with developing new edits for COSMOS based on CMS rules and regulations, boost plan savings, and potentially improve STAR ratings
  • Coordinate, develop, implement and evaluate departmental process designs
  • Establish ongoing communication of issues and improvement recommendations to share with process owners and senior management throughout the life of assigned projects
  • Work with management to define risk mitigation action and to resolve process gaps
  • Supervision of the SOS team, which includes:
    • Manages the QA for STARS / HEDIS provider outreach faxes for both the medication adherence and DNSP medication reconciliation projects
    • Manages the Provider email inbox for STARS / HEDIS inquiries, working across multiple departments for potential resolution and record acquisition
    • Develops the process and managing quality validation for provider demographic information related to STARS / HEDIS chases
    • Provider escalation unit - includes actively working escalated cases across various departments to prevent CTMs, Executive Complaints, DOI complaints, Legal issues, Contract Terminations, etc.
Required Qualifications:
  • High School Diploma / GED
  • 5+ years of experience working within a Medicare environment
  • 2+ years of supervisory experience
  • Medicare Policy Subject Matter Expert
  • Project Management experience
  • The ability to interpret and comprehend CMS regulations, the federal register and legal documents is required
Preferred Qualifications:
  • Legal writing experience is a plus
  • Provider relations experience is a plus
  • Background in claims processing and / or appeals
Soft Skills:
  • Ability to write clear, professional communications for internal and external contacts
  • Ability to monitor and evaluate ongoing activities and recommend process improvements
  • Experience in a position requiring excellent written and verbal communication skills
  • Ability to set work priorities and complete tasks in a timely manner
  • Experience dealing with conflict, changing work environment, problematic personnel and partners and competing priorities
  • Self-motivated and flexible
  • Excellent organizational and time management skills
  • Demonstrated ability to exercise good judgment, initiative, and tact in dealing with providers, vendors, and internal contacts
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can 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.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: UnitedHealth Group, San Antonio, Manager Business Process, Medicare, Project Management, CMS Regulations

Job Details

  • Contest Number745707
  • Job TitleManager Business Process - San Antonio, TX
  • Job FamilyClaims
  • Business SegmentUHC Benefit Ops - Provider Svc

Job Location Information

  • San Antonio, TX
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelManager
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusExempt

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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