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Manager of Quality, Oversight, Appeals and Clinical - South

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Job Details
Job Order Number
Company Name
UnitedHealth Group
Physical Address

South Portland, ME 04116
Job Description

Welcome to one of the
toughest and most fulfilling ways to help people, including yourself. We offer
the latest tools, most intensive training program in the industry and nearly
limitless opportunities for advancement. Join us and start doing your life’s best work .

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.(sm)

in this position are responsible for supporting the Financial Protection Claims
Organization (Family Medical Leave, Short Term Disability, Long Term
Disability, Life, Life Waiver of Premium, Accident, Critical Illness, Hospital
Indemnity) with regard to quality assurance, reinsurance oversight, appeals and
clinical. They will effectively and
professionally utilize sound judgment, technical knowledge, communication
skills, and resources (within the Claims Organization, across departments,
external parties, etc.) to meet the needs of the Financial Protection
Organization. Additional
responsibilities may include, but are not limited to: Oversee audit function (and any vendor
support) and validate that a percentage of claims within all product lines will
be audited on a scheduled basis, work with Claim Managers and reinsurers in reviewing
audit results and providing feedback to Best Practice Unit and affected claim
teams, address trends through audits and support improvement by initiating
change through the appropriate training; prepare and distribute monthly
Reinsurer Quality Score card; oversee Appeals team and ensure compliance with
state and federal regulations; monitor adherence to established claim services
standards, protocols and external guidelines including reinsurers; oversee
Clinical team to include RNs to ensure the workflow and customer service
standards are met in support of the claims teams; manage project work for the
organization; and managing the system administrator and system enhancements.

Primary Responsibilities :

+ Ability to multitask and shift priorities quickly, professionally and positively to accommodate urgent tasks and to reach team, business area, and corporate goals

+ Ability to interact professionally with all internal and external customers, including peers, members of other business areas/segments, attorneys, etc.

+ Appropriately apply policies and procedures to ensure successful compliance with internal and external guidelines

+ Solid understanding of organizational structure; ability to facilitate issues through appropriate channels, including how and when to involve management

+ Work effectively and partner with others to contribute to a team environment

+ Adhere to appropriate response and turnaround times on required reporting

+ Assess customer needs and requirements, especially non-standard requests and problems, and respond or refer to appropriate resources

+ Teach, coach, and mentors others

+ Demonstrate role model behavior regarding the core values of Integrity, Compassion, Relationships, Innovation, Performance

+ Demonstrate a positive attitude

+ Be accountable

+ Consistently meets established productivity, schedule adherence, and quality standards

+ Treat everyone with dignity and respect

+ Demonstrate Open and Honest Communication

+ Remain available/approachable

+ Understand UnitedHealth Group’s Pay For Performance culture

+ Strong commitment to continuous learning and process improvement

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 (or higher)

+ 5+ years of experience in Financial Protection products (short and long term disability, life insurance, life waiver of premium, critical illness, accident, hospital indemnity, and FMLA)

+ 3+ years of experience in Financial Protection product claims processing

+ 2+ years of experience in people / team management

+ Advanced experience in Microsoft Excel (VLOOKUP, pivot tables, formulas, formatting, charts/graphs, sort/filter) and PowerPoint (create new presentations, adding effects/sounds/transitions, presentation skills)

+ Proficiency with computer and Windows PC applications with the ability to use multiple computer systems/applications


+ BA/BS degree (or higher) in related field such as Business, Finance, or Marketing

+ Project management experience

Soft Skills:

+ Solid communication skills, including the ability to listen objectively and articulate the facts of an issue verbally and in writing

+ Strong organizational skills

+ Solid conflict resolution skills

+ Ability to make timely, confident decisions based on available data/facts

+ Ability to take direction; respond to requests and feedback

+ Ability to collaborate across all levels of organization for successful outcomes

+ Demonstrate initiative and willingness to learn new tasks

+ Motivated to work independently and remain focused on the task(s) at hand in the face of shifting obstacles to complete assigned tasks

Careers atUnitedHealthcare Employer & Individual . We all want to make a difference

with the work we do. Sometimes we’re presented with an opportunity to make a
difference on a scale we couldn’t imagine. Here, you get that opportunity every
day. As a member of one of our elite teams, you’ll provide the ideas and
solutions that help nearly 25 million customers live healthier lives. You’ll
help write the next chapter in the history of health care. And you’ll find a
wealth of open doors and career paths that will take you as far as you want to
go. Go further. This is your life’s best work.SM

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.

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

manager, management, project management, Business, Finance, Marketing, claims
processing, Financial Protection

To view full details and how to apply, please login or create a Job Seeker account.