Claims Manager - New York, NY

New York, NY, United States

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best.Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale.Join us to start Caring. Connecting. Growing together.

The Claims Manager is responsible for overseeing and managing the claims billing process at AbleTo. This role includes leading a team of claims analysts, ensuring accurate and timely submission of claims, resolving billing discrepancies, and collaborating with cross-functional teams to resolve disputes, optimize billing processes, and set up new insurance carriers. The Claims Manager plays a crucial role in maintaining revenue integrity and compliance with healthcare regulations, as well as contributing to the overall financial health of the organization.

Primary Responsibilities:

Claims Processing:

Oversee the end-to-end claims processing cycle, ensuring accuracy, efficiency, and compliance with established policies and procedures

Establish Electronic Funds Transfers (EFTs), Electronic Remittance Advice (ERAs), and oversee claims testing for new insurance carrier implementations

Collaborate with internal teams to address escalated inquiries and resolve disputes

Ensure timely communication and responses to claims inquiries and concerns

Other duties, as needed.

Process Improvement, Reporting, and Analytics: Monitor and analyze key performance indicators (KPIs) related to billing and revenue cycle operations

Identify process improvement opportunities to enhance efficiency, accuracy, and patient satisfaction

Maintain accurate records of billing activities, claim submissions, and payment receipts

Team Leadership: Supervise, Train, and Manage a team of Claims Analysts

Set performance goals, provide regular feedback, and conduct performance evaluations

Foster a collaborative and productive work environment within the claims team

Training and Development: Provide ongoing training and development opportunities for the Claims team to enhance their skills and knowledge

Create or Update existing training materials and Standard Operating Procedures (SOPs) to support enhanced processes

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:

Bachelor's degree in Healthcare Management, Business Administration, or related field

Minimum of 4+ years of experience in claims management or billing, with 2+ years in a supervisory or managerial role

In-depth understanding of medical billing, coding practices, and claims processing procedures

Efficient analytical and problem-solving skills, with the ability to make data-driven decisions using available resources

Excellent communication and interpersonal skills to collaborate with internal and external stakeholders

Knowledge of healthcare regulations (e.g., HIPAA, Medicare, Medicaid) and industry compliance standards

Leadership skills to manage a diverse team and drive performance improvements

Solid organizational skills with the ability to prioritize tasks, manage multiple responsibilities simultaneously, and document findings thoroughly

Preferred Qualifications:

Experience using analytical tools - Excel, Gsheets, Looker, Tableau, etc

Familiarity with electronic health record (EHR) systems and medical billing software

Experience using ticketing software - Jira, DeskPro, etc

New York Residents Only: The salary range for this role is $48,300 to $94,500 annually. 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.

#RPO #RED