1+ months

Manager of Quality, Oversight, Appeals and Clinical - South Portland, ME

South Portland, ME 04106
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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)


Individuals 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.

Posted: 2019-12-06 Expires: 2020-03-06

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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Manager of Quality, Oversight, Appeals and Clinical - South Portland, ME

UnitedHealth Group
South Portland, ME 04106

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