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Manager, Enhanced Provider Validation - Telecommute

UnitedHealth Group

Eden Prairie, MN
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Job Details

743331 Manager Enhanced Provider Validation Telecommute

Manager, Enhanced Provider Validation - Telecommute (743331)

Position Description

If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm)


The Enhanced Provider Validation Manager oversees a team of employees ranging from 15 - 20 direct reports consisting of analysts, non-clinical, and coders. Day to day management includes employee development, revenue / savings management, expense management, project management, client management / implementation.


You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.


Primary Responsibilities:

  • Manages and is accountable for professional employees responsible for preventing and recovering inappropriate claim payments related to health insurance; this includes enhanced provider validation and phantom investigation on tips and allegations to identify potential Fraud, Waste, Abuse, or Error
  • Manages a team of analysts and non-clinical investigators and will be responsible for:
    • Monitoring attendance, productivity, utilization, throughput, receipts, scorecards, dashboards, and quality to ensure that all metrics and TATs are met in order to comply with SLAs
  • Communicate daily, weekly, monthly results
  • Facilitate team meetings
  • Accountable for departmental documentation
  • Accountable for financial and non-financial results (budgets and actuals)
  • Sets team direction, resolves problems and provides guidance to members of team
  • Adapts departmental plans and priorities to address business and operational challenges
  • Influences or provides input to forecasting and planning activities
  • Assist with various process improvement initiatives and participate actively in Six Sigma activities and redesign of team process
  • Guide and direct staff in their personal and professional development
  • Counsel under-performers and recognize top performers
  • Ensure individual and corporate productivity and quality metrics are achieved

Required Qualifications:

  • Bachelor's Degree
  • 2+ years of demonstrated understanding of fraud and abuse principles and health insurance
  • 1+ years of management experience
  • 1+ years of operations management experience
  • Intermediate proficiency in Microsoft Word, Excel, and PowerPoint

Preferred Qualifications:

  • 1+ years of Project Management experience
  • 2+ years of claims platform experience
  • 2+ years of fraud and abuse investigative experience

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)


*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy



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.



Job Keywords: fraud, abuse, TIN, medical claims, fraud investigation, investigators, certified medical coders, telecommute, remote, work from home

Job Details

  • Contest Number743331
  • Job TitleManager, Enhanced Provider Validation - Telecommute
  • Job FamilyBusiness Operations
  • Business SegmentOptum Operations

Job Location Information

  • Eden Prairie, MN
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelManager
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionYes
  • 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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