UMR, UnitedHealthcare’s third-party administrator (TPA) solution, is the nation’s largest TPA. When you work with UMR, what you do matters. It’s that simple . . . and it’s that rewarding.
In providing consumer – oriented health benefit plans to millions of people; our goal is to create higher quality care, lower costs and greater access to health care. Join us and you will be empowered to achieve new levels of excellence and make a profound and personal impact as you contribute to new innovations in a vital and complex system. Opportunities are endless for your career development and advancement within UMR due to our record-breaking growth.
Regardless of your role at UMR, the support you feel all around you will enable you to do what you do with energy, quality, and confidence. So, take the first step in what is sure to be a fast – paced and highly diversified career.
The Special Investigation Unit Manager leads a team tasked with the responsibility of detecting, investigating, and determining future action on potential fraudulent billing activity. We are seeking a candidate who is curious, innovative, and passionate about serving our customers through effective cost containment. Strong communication skills and the ability to thrive in a changing environment are essential. You’ll have all the tools and backing you need to help analyze claims and ensure adherence to procedures and compliance policies. All the while, you’ll be building your career with a leader and reaching for the highest levels of performance as you do your life’s best work.
This position is full time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7am – 5pm in their time zone. It may be necessary, given the business need, to work occasional overtime.
We offer weeks of on-the-job training. The hours during training will be 7:00am to 5:00pm in their time zone, Monday – Friday. Training to be discussed further during interview process. Training will be conducted virtually from your home.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Monitor and enforce adherence to policies, providing coaching as needed
Identify and resolve operational problems using defined processes, expertise, and judgment
Recommend and implement procedures to improve existing or new processes
Lead complex projects related to internal departments and external partnerships
Assist with escalations, including but not limited to determining root cause of issue, documenting findings, and communicating outcome
Collaborate with the larger Payment Integrity Team on initiatives and goals surrounding enhanced cost containment
Present information to internal and external customers
Collaborate with the larger Payment Integrity Team on initiatives and goals surrounding enhanced cost containment
Strong interpersonal skills: ability or desire to learn how to run small group meetings and meetings involving internal/external customers
Excellent business, oral and written communication skills with the ability to clearly articulate information in a clear and concise manner
Ability to handle a fast-paced environment with pressure based on project deadlines or required performance guarantees
You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
High School Diploma / GED with equivalent work experience
Must be 18 years of age or older
3+ years of experience with analyzing and solving customer problems
2+ years of previous leadership experience
2+ years of experience leading complex analytical projects including presenting findings to internal and/or external leadership level audience
2+ years of experience with previous OR current UMR – Claims Processing System (UMR CPS). UMR is UnitedHealthcare’s third-party administrator (TPA) solution. You must be an employee of UMR specifically to have experience with the UMR claims system.
1+ years of experience with medical coding
Experience creating new processes and procedures to streamline a workflow within the organization
Experience with using Microsoft Word (ability to create, edit, copy, send, and save documents), Microsoft Excel (ability to create, edit, copy, send, and save spreadsheets), and Microsoft Outlook (ability to create, edit, copy, send, and save correspondence)
Ability to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 5:00pm in their time zone.
Telecommuting Requirements:
Ability to keep all company sensitive documents secure (if applicable)
Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.
Soft Skills:
Strong interpersonal skills; ability or desire to learn how to run small group meetings and meetings involving internal/external customers
Excellent business, oral and written communication skills with the ability to clearly articulate information in a clear and concise manner
Ability to handle a fast-paced environment with pressure based on project deadlines or required performance guarantees
Organized and detail oriented
Skill set to manage a fast paced, large, production team with quick turnaround time requirements
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $71,200 – $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location, and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.
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