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Team Lead - Capitation, Eligibility and Support - Irvine, CA

UnitedHealth Group

Irvine, CA
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Job Details

747381 Team Lead Capitation Eligibility and Support Irvine CA

Team Lead - Capitation, Eligibility and Support - Irvine, CA (747381)

Position Description

The Team Lead - Capitation, Eligibility and Support may assist the Supervisor or Manager with overseeing and accounting of day to day operations of the Capitation Specialists, Eligibility Coordinators, and Business Operations Support Team. The Capitation, Eligibility and Support Lead may also collaborate with internal departments on contract requirements, capitation rates, monthly account reconciliation, oversight and monitoring reports, data accuracy, reporting, and system functionality.


Primary Responsibilities: 

  • Ensure the coordination, calculation, and distribution of payment of monthly PCP & Specialist capitation

  • Audits of capitation system setups, contracts, calculations, and end of month reconciliations; position is also backup for all Capitation Specialist duties

  • Have ability to work with Eligibility Coordinators to correct research, entry, or notation issues

  • Ensure daily Business Operations Support duties are completed timely and accurately

  • Participate in training of Capitation Specialists, Eligibility Coordinators and Support staff and assist with work prioritization as needed

  • Review all oversight and monitoring reports, and report anomalies to management and strategize on their reconciliation

  • Report any staffing issues to next level of Management

  • Any other duties as assigned

Required Qualifications:

  • High school diploma or equivalent

  • 2+ years experience with healthcare eligibility, claims, customer service or a combination

  • 1+ year of experience in customer service

  • Strong research and analytical skills

  • Excellent interpersonal skills at both an individual and team level

  • Excellent written and verbal communication skills

  • Intermediate proficiency with MS Office

Preferred Qualifications:

  • Advanced degree

  • Accounting experience and/or EZ Cap experience

  • Experience with claim processes, workflows, and management reporting

  • Previous experience with team leadership, SME, training, project leadership or project management

What's the first thing that happens when one of the most successful physician groups in Orange County comes together with a global leader in health care? Opportunity. With Monarch HealthCare joining Optum and the UnitedHealth Group family of companies, people like you will find increasing levels of challenge, impact and professional success. With a vibrant network of hospitals and urgent care centers, we're changing health care for the better by improving access to affordable, high quality care, and working together to improve the patient experience. That takes passion, commitment, intense focus and the ability to contribute effectively in a highly collaborative team environment. Are you with us? Learn more about this exciting opportunity 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.


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



Job Keywords: claims, customer service, accounting, EZ Cap, SME, Irvine, CA, California

Job Details

  • Contest Number747381
  • Job TitleTeam Lead - Capitation, Eligibility and Support - Irvine, CA
  • Job FamilyNetwork Management
  • Business SegmentOptumCare

Job Location Information

  • Irvine, CA
    United States
    North America

Additional Job Detail Information

  • Employee StatusRegular
  • ScheduleFull-time
  • Job LevelIndividual Contributor
  • ShiftDay Job
  • TravelNo
  • Telecommuter PositionNo
  • Overtime StatusNon-exempt

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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