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Supervisor Claims - Schaumburg, IL

UnitedHealth Group


Location:
Schaumburg, IL
Date:
02/20/2018
2018-02-202018-03-21
Job Code:
743708
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Job Details

743708 Supervisor Claims Schaumburg IL

Supervisor Claims - Schaumburg, IL (743708)

Position Description

Position Description:


We didn't get here by accident. UnitedHealth Group is a Fortune 6 leader in health care because we are an undisputed leader in creating service quality and helping to improve the lives of millions. Now, let's get you over here and keep building on that reputation. In this role, you'll be responsible for reviewing, researching, investigating and triaging all types of claims, appeals and grievances. You'll drive the action and communicate with appropriate parties regarding claims issues. In return, we'll provide you with great training, support and opportunities.


The Manual Claims Supervisor leads the team in processing all manual claims submitted by members, pharmacies and other organizations in addition to performing activities that include recruiting, training, and employee performance management.  Oversight of daily operations is required to ensure that client performance guarantees and Med D compliance is met and to ensure the continuous improvement of the paper claims processing functions.  This position requires solid leadership in all claims processing aspects and interfaces cross-functionally with other departments. 


This is a challenging role with serious impact. We'll look to you to motivate and empower your team to provide best in class service. You'll need to combine expertise and exceptional claims support with analyzing and researching complex claims.

     

Primary Responsibilities

General Supervisor:

  • Supervise and direct the claims staff, including performance counseling and yearly performance evaluation. Ensure that regular feedback is provided to employees regarding performance particularly as related to productivity and quality.
  • Supervise and support claims staff day-to-day activities to consistently meet established productivity, schedule adherence and quality standards.
  • Responsible to ensure the proper training for employees.
  • Monitor claim volumes and evaluate additional resource requirements.
  • Oversee the recruiting process for new hires in conjunction with Human Resources to establish candidate requirements, overall recruiting strategy and conduct interviews.
  • Establish departmental performance standards and coach individual employee performance to meet and exceed production and quality metrics.
  • Participate in writing and updating manual claims procedures.
  • Exhibit active support of five core values – Integrity, Compassion, Relationships, Innovation and Performance.
  • Actively collaborate with management and staff to ensure that "best practices" are followed and continually seek efficient and innovative processes, technologies and approaches to optimize use of resources and enhance operations. 
  • Responsible for resolution of escalated issues, claims research and coordinating with Account Management, Customer Care and Benefit Administration teams as needed. 
  • Answer claim questions from within team, internal departments, clients and/or members.

Client Relationships

  • Manages the client implementation process for Manual Claims by documenting and establishing routine procedures for processing claims for new clients.  
  • Coordinates with the Benefit Administration and Implementations teams as needed.
  • Assist clients (internal and external) in member service and reconciliation

Communication and Reporting

  • Analyze and identify trends and provide reports as necessary.
  • Ensure the timely and accurate reporting of various team/departmental management performance measurements such as productivity, quality, and processing turnaround times, etc.
  • Closely monitor claims processing turnaround times and claims aging and ensure these are in alignment with client performance guarantees and CMS requirements.  
  • Follows all policies and procedures related to job responsibilities.
  • Exhibit compliant and ethical behavior in the performance of job responsibilities, including compliance with all applicable federal and state laws and regulations, company Code of Conduct, Business Ethics Policies and Procedures and other policies and procedures applicable to position.
  • Performs other duties as assigned to meet corporate objectives.

Requirements:

  • Bachelor's Degree (or higher) OR High School Diploma / GED with 2+ years of supervisory experience within a pharmacy or medical claims department   

  • Prior Supervisory and / or Team Lead experience

  • Experience with pharmacy or medical claims processing

  • Proficiency within Microsoft Excel (filter, sort, create and edit spreadsheets)

  • Proficiency within Microsoft Word (create and edit documents)

Preferred Qualifications:

  • Knowledge of Medicare Part D compliance requirements and regulations

  • Experience with internal claims systems is preferred (RxCLAIM, ServiceNow, RxTRACK)

OptumRx is an empowering place for people with the flexibility to help create change. Innovation is part of the job description. And passion for improving the lives of our customers is a motivating factor in everything we do.

 

If you're ready to talk about groundbreaking interactions, let's talk about what happens when a firm that touches millions of lives decides to gather results from millions of prescriptions every month and analyze their impact. Let's talk about smart, motivated teams. Let's talk about more effective and affordable healthcare solutions. This is caring. This is great chemistry. This is the way to make a difference. We're doing all this, and more, through a greater dedication to our shared values of integrity, compassion, relationships, innovation and performance.  Join us and start doing 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, Supervisor, Claims, Schaumburg, IL, medical claims processing, pharmacy, healthcare, RxCLAIM, ServiceNow, RxTRACK

Job Details

  • Contest Number743708
  • Job TitleSupervisor Claims - Schaumburg, IL
  • Job FamilyClaims
  • Business SegmentOptumRx

Job Location Information

  • Schaumburg, IL
    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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