Operations Service Manager – OSM – Premier Account

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together. 

 

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 powered 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.

 

Positions in this function are responsible for the ongoing operational support for the medical benefits for new and renewing customers, directly interacting with the customers as well as the entire UMR set of functions responsible for the overall operations and service to the customer, first-level response and resolution of escalated issues with external and internal customers, and ensuring business to business partners within the operations space have the tools, support, and resources necessary to be successful in their operations serving our joint customer(s). Responsible for the overall delivery of benefits and services by providing support and guidance to UMR’s newest premier account, operational business partner to support the premier account, and to ensure continued membership.

 

This position is full-time, Monday – Friday. Employees are required to work our normal business hours of 8:00am – 5:00pm EST. It may be necessary, given the business need, to work occasional overtime.

 

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

 

Primary Responsibilities:

• Works independently to manage own tasks and applies knowledge/skills to a range of complex activities

• Demonstrates great depth of knowledge/skills in own function and increased knowledge/skills in other functions such as coding, networks, integration, HRA, HCR regulations, etc

• Proactively identifies non-standard requests and potential problems; investigates and solutions using defined processes, expertise and judgement.  Resolution is determined by use of knowledge, research, and internal contacts

• Identify potential claim and / or customer service issues and create a plan to ensure risk is minimized

• Consults with key business partners outside of team to ensure benefit intent is understood based on source documents and output matches (coding, SAE, PNO, network services, integration support)

• Serve as the liaison to a complex premier account to manage first level response and resolution of escalated issues with external and internal customers, including a complex business partnership

• Identify and resolve operational problems using undefined processes, expertise and judgment

• Investigate claim and / or customer service issues as identified and communicate resolution to customers

• Responsible for maintaining customer’s medical plans installation documents

• Responsible for testing customer benefit changes in CPS

• Create and update HPDB’s

• Identify the need for and providing specific and remedial training to internal UMR staff as well as external business partner staff working in UMR’s ecosystem

• May act as a resource for others and coordinate other activities

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)
• 3+ years of customer service experience analyzing and solving customers’ problems
• 1+ years of experience with UMR CPS (Must be within UMR business line)
• 1+ years of experience working within cross functioning departments of UMR
• 1+ years of experience with CPS medical installation documents and implementation checklists
• Ability to work our normal business hours of 8:00am – 5:00pm EST. It may be necessary, given the business need, to work occasional overtime

Preferred Qualifications:

• 3+ years medical claim processing experience in CPS
• Current OR previous experience as Operations Service Manager within UMR
• Experience with Microsoft Excel (creating basic formulas, creating and managing pivot tables)
• Experience utilizing Microsoft Word (creating and editing documents) and Microsoft Outlook (creating and sending emails)

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

 

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

For more information on our Internal Job Posting Policy, click here.

     

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 hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 

    

 

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. 

    

 

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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