UnitedHealth Group

Operations Manager (Payment Integrity) - San Juan, PR

UnitedHealth Group$90K — $120K *
Healthcare
Less than 5 years of experience
Job Overview by Ladders

Qualifications

  • 3+ years of experience in healthcare operations leadership roles
  • 2+ years of people management experience
  • 2+ years utilizing operational metrics and performance measures to drive outcomes
  • Experience in operational improvements in healthcare or Payment Integrity
  • Knowledge of healthcare compliance and regulatory requirements
  • Proficient in Microsoft Office Suite
  • Demonstrated ability to manage competing priorities in a high-change environment

Responsibilities

  • Lead a team to resolve complex provider inquiries and escalations
  • Establish relationships with internal and external stakeholders
  • Drive high-priority escalations resolution through collaboration
  • Facilitate executive meetings and discussions
  • Monitor operational performance metrics to meet business objectives
  • Conduct root cause analysis to improve performance outcomes
  • Analyze data to identify opportunities for efficiency gains

Benefits

  • Support for professional development and growth opportunities
  • Recognition for performance in a challenging environment
  • Clear direction for success in the role
  • Culturally inclusive work atmosphere promoting accountability and engagement
Full Job Description
The Manager of Administrative Coding is part of the leadership team overseeing Optum's Behavioral Payment Integrity (PNI) Operations; specific to Fraud, Waste, Abuse, & Error (FWAE) investigations. This position is responsible for the strategic direction and execution of the Optum Behavioral administrative coding review team.

Primary Responsibilities:

  • Lead and develop a team responsible for resolving complex provider inquiries, escalations, and Payment Integrity operational issues
  • Establish and maintain trusted relationships with senior internal and external stakeholders, including UHN, UHC Payment Integrity, Network Management, and Provider Relations partners
  • Drive resolution of high-priority escalations through collaboration with Operations, Analytics, Reporting, Medical Directors, Compliance, and Legal partners as appropriate
  • Facilitate executive-level meetings, discussions, and Q&A sessions with leadership stakeholders
  • Monitor production, quality, turnaround time, service-level agreements, and operational performance metrics to ensure successful delivery of business objectives
  • Prioritize work queues and implement contingency plans when operational targets are at risk
  • Lead root cause analysis and corrective action planning to address recurring operational issues and improve performance outcomes
  • Analyze trends, performance data, and operational metrics to identify opportunities for process improvements, efficiency gains, and risk mitigation
  • Partner with business leaders to anticipate future operational needs and support workforce planning strategies
  • Develop executive presentations, business reviews, and leadership materials that communicate operational performance, risks, opportunities, and strategic recommendations
  • Influence and drive alignment across multiple business functions without direct authority
  • Supervise, coach, mentor, and develop a team, fostering a culture of accountability, engagement, and continuous improvement
  • Partner with global and enterprise stakeholders to support strategic initiatives, operational objectives, and business growth opportunities


ENGLISH PROFICIENCY ASSESSMENT WILL BE REQUIRED AFTER APPLICATION

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:

  • 3+ years of experience in provider-facing, client-facing, or healthcare operations leadership roles
  • 2+ years of people management experience
  • 2+ years of experience utilizing operational metrics, analytics, dashboards, and performance measures to drive business outcomes
  • Experience leading operational improvements in a healthcare, claims, or Payment Integrity environment
  • Experience working within healthcare compliance and regulatory requirements
  • Experience developing business cases, managing projects, and achieving measurable operational or financial results
  • Experience partnering with senior leaders and navigating matrixed organizations
  • Experience with Fraud Waste & Abuse or Payment Integrity
  • Knowledge of healthcare claims platforms and end-to-end claims operations
  • Proficiency with Microsoft Office Suite, including Excel, PowerPoint, Word, and Outlook
  • Professional proficiency in English
  • Demonstrated ability to work a flexible schedule during normal business hours and support occasional overtime or weekend business needs
  • Demonstrated ability to manage competing priorities in a fast-paced, high-change environment


Preferred Qualifications:

  • Registered Nurse (RN) license
  • Certified Coder
  • Experience with provider relations, network management, or network contracting practices
  • Experience managing budgets and financial performance
  • Experience developing and executing growth, operational excellence, or transformation strategies

About UnitedHealth Group

UnitedHealth Group is a medical facility. They offer health technology, health finance, and pharmacy services. They are utilizing clinical data and intelligence to assist in the redesign, automation, and deployment of technology to streamline administrative operations and clinical decision-making. Payment systems for both consumers and providers are critical components of a health-care system.

UnitedHealth Group Careers

Joining UnitedHealth Group means becoming part of a diverse team dedicated to making a difference. As a leader in health services and innovation, our company offers a variety of job opportunities that allow professionals to leverage their skills, drive innovation, and improve lives. Work You’ll Do At UnitedHealth Group, you’ll contribute to a mission-focused environment where your expertise will influence the health and well-being of people worldwide. Our employment opportunities span across a wide range of disciplines, from healthcare specialists to data analysts, ensuring that your career journey is both dynamic and rewarding. Transform Healthcare with Your Expertise UnitedHealth Group stands at the forefront of health innovation. Our team collaborates to deliver solutions that lead to better patient outcomes. Working with us, you’ll find yourself at the intersection of technology, healthcare, and leadership, providing key insights that drive industry transformation. Join Our Global Team As part of our team, you’ll engage with over 300,000 professionals globally, dedicated to building a diverse and inclusive workplace. UnitedHealth Group is not just a company; it’s a community where you can grow your career through continuous learning and leadership opportunities. Our commitment to diversity training ensures that every team member can thrive. UnitedHealth Group Career Development We are committed to your professional growth. Explore career paths filled with promising job opportunities and internships that will harness your potential and expand your capabilities. Whether you’re a seasoned professional or a recent graduate, you’ll find that our career development programs support your ambition at every level. Innovative Work Environment At UnitedHealth Group, innovation is at the core of our operations. We encourage our team to bring forward-thinking ideas that challenge the status quo and lead to breakthrough improvements in patient care. Be Part of a Great Team Our culture fosters a collaborative and supportive environment where every member’s contribution is valued. Enjoy the benefits of being part of a global team that’s committed to making a difference in people’s lives. Future-Proof Your Career With UnitedHealth Group, your career is future-proof. Dive into a range of positions that offer both challenges and rewards. Our robust support system includes unmatched training, development programs, and certification support to propel your career forward. Stay Connected Join Our Team Discover the right position that matches your skills and interests. We are always hiring and look for passionate, curious, and solution-driven team players. Search UnitedHealth Group jobs today and take the first step towards a fulfilling career. Keep Up to Date Stay informed with career tips, insider perspectives, and industry-leading insights you can use today—all from the people who work here. Read Careers Blog Job Alert Emails Customize your subscription to receive job alerts, the latest news, and insider tips tailored to your preferences. Explore the exciting and rewarding opportunities that await at UnitedHealth Group.
Learn more about UnitedHealth Group
Size
350,000 employees
Market Cap
$493.1 billion
Industry
Net Income
$15.4 billion
Founded
1974
5 Year Trend
+9.2%
Revenue
$257.1 billion
NASDAQ

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