Operations Service Manager – Mentor – National Remote

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.

Positions in this function are responsible for keeping their existing customers while taking on the additional responsibility of becoming a mentor of the OSM mentor team and mentoring and supporting new Operations service Managers. Positions in this function are also responsible for first – level response and resolution of escalated issues with external and internal customers. Responsible for the overall delivery of benefits and services by providing support and guidance to existing and potential customers to ensure continued membership. This position will continue to report to their current Manager.

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

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

 

Primary Responsibilities:

• Mentoring and supporting new Operations Service Managers
• Serve as the liaison to a complex customer base to manage first level response and resolution of escalated issues with external and internal customers
• 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 during implementation 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)
• Identify and resolve operational problems using defined 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 processors or CFR’s
• Large claim file reviews
• Monitor large dollar claims – for stop loss
• Respond to SBA and external vendor audits
• May act as a resource for others
• May coordinate others 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
• Must be 18 years of age OR older
• 3+ years of Customer Service experience with analyzing and solving customer’s problems
• Experience with working within cross functioning departments of UMR
• 1+ years of Current / Previous experience as an Operations Service Manager within UMR
• Experience with CPS medical installation documents and implementation checklists
• Experience with UMR CPS (UMR is UnitedHealthcare’s third – party administrator (TPA) solution and you must be an employee of UMR specifically to have experience with the UMR claims system)
• Ability to work any of our shift schedules during our normal business hours of 8:00 AM – 5:00 PM CST from Monday – Friday. It may be necessary, given the business need, to work occasional overtime or weekends.

 

Preferred Qualifications:

• Experience with utilizing Microsoft Word (creating and editing documents)
• Experience with utilizing Microsoft Excel (creating basic formulas, creating and managing pivot tables)
• Experience with utilizing 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 employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy  

  

The hourly range for this role is $28.61 to $56.06 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

 

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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