Claims Supervisor - Remote in CA

Optum CA is seeking a Claims Supervisor to join our team in California. Optum is a clinician - led care organization that is changing the way clinicians work and live.

As a member of the Optum Care Delivery team, you'll be an integral part of our vision to make healthcare better for everyone.

At Optum, you'll have the clinical resources, data and support of a global organization behind you so you can help your patients live healthier lives. Here, you'll work alongside talented peers in a collaborative environment that is guided by diversity and inclusion while driving towards the Quadruple Aim. We believe you deserve an exceptional career, and will empower you to live your best life at work and at home. Experience the fulfillment of advancing the health of your community with the excitement of contributing new practice ideas and initiatives that could help improve care for millions of patients across the country. Because together, we have the power to make health care better for everyone. Join us and discover how rewarding medicine can be while Caring. Connecting. Growing together.

Supervises the daily production and quality of the Claims Auditors and outsourced Claims Analysts. Ensures that claims processing quality and production meet SCPMCS and Client guidelines. Ensures that claims processing including member denials and provider disputes meets or exceeds DMHC and CMS regulations. Manages the relationship with Calibrated for analyst support.

This position is full time, Monday - Thursday. Employees are required to work a 10-hour shift schedule during the normal business hours of 5:45 AM - 4:15 PM PST. It may be necessary, given the business need, to work occasional overtime.

This will be paid on-the-job training and the hours during training will be aligned with your schedule.

If you are located in within the state of California, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

This description is not exhaustive and may be modified on a temporary or regular basis at the discretion of SCPMCS. SCPMCS expects that its' employees will need to assume other "non - essential functions" not listed herein which support company business objectives. This may include duties that fall outside of the normal position scope.

• 30% Supervises the activities and production / quality of the Claims Auditors
  
  
  
  
  • Ensures accurate and timely review of PDRs, Member Denials, and claims compliance
  • Ensures member maximum out of pocket notification are appropriately handled through reprocessing / reimbursement of claims and coordination with Finance
  
  
  
  
• 20% Supervises the activities and production / quality outsourced claims analysts; Acts as liaison with the Calibrated claims manager
• 20% Is the primary Claims Department resource for other SCPMCS departments regarding processing questions
• 15% Assists the Claims Manager in completing health plan inquiries and helps monitor HPInqClaims mailbox
• 5% Coordinates the daily check runs; Collaborates with Finance to coordinate the weekly check run schedule for claims and voids to comply with regulated timeliness guidelines and within Client specifications
• 5% Assists the Clams Manager in policy / procedure review and revision as indicated
• 5% Uses CQI (Continuous Quality Improvement) principles as a guideline for assessing and re - assessing procedures and process with the goal towards increased productivity, quality outcomes, and cost effectiveness
• Other duties as assigned

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 experience in claims processing
• Understanding of reimbursement methodologies and standard payment fee schedules (Medi - Cal, Medicare, RBRVS)
• Familiarity with Claims coding / unbundling software
• Working knowledge of word processing and spreadsheet development
• Ability to interact positively with staff and other SCPMCS management
• Ability to work any of our 10-hour shift schedules during the normal business hours of 5:45 AM - 4:15 PM PST from Monday - Thursday

Preferred Qualifications:

• Previous Supervisor experience

Telecommuting Requirements:

• Reside within the state of California
• 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

Soft Skills:

• Excellent organizational skills
• Good written and oral communication skills

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

The salary range for this role is $49,300 to $96,400 annually 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.

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.

Diversity 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.

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

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