Director of Claims (Healthcare) - La Palma, CA

    • Cerritos, CA

Position Description

The Director of Claims will be responsible for the direction and oversight of the claims department. Ensures compliance with Federal and State regulations and has oversight for all health plan audits. Review, create and or maintain workflows to ensure up to date and operational efficiency.

Primary Responsibilities:

  • Provides leadership and direction to claims staff
  • Develop and implement policies and procedures in collaboration with senior management
  • Analyze systems and tools to identify opportunities for efficiency improvements
  • Liaison between the health plans with regards to claim audits and issues
  • Generates claims metric reports and analyze various monthly reports
  • Oversees the development and implementation of training to the claims staff
  • Provides presentations to staff and management
  • Able to perform root cause analysis that may cause claims non-compliance
  • Participates on-site meetings with internal and external customers
  • Promote and contribute to a fair, positive and professional work environment through both management style and personal example
  • Performs other duties as directed

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:
  • 5+ years of experience in the following areas:
    • Extensive and specialized knowledge of claims
    • Healthcare Claims Management experience
    • Experience with claims compliance guidelines
  • 3+ years of experience managing direct reports
  • Experience with Health Plan audits
  • Excellent written and verbal communication skills.
  • Problem solving and independent critical thinking skills.
  • Intermediate proficiency with Word and Excel

Preferred Qualifications:
  • Bachelor's degree preferred
  • Experience in a Managed Care environment
  • Intermediate proficiency with PowerPoint

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

AppleCare Medical Group was formed in Lynwood, California in 1996 with the goal of making quality care available locally to the community. Today, AppleCare Medical Group is comprised of hundreds of board-certified private-practice, independent physicians. These physicians provide medical expertise and passion to improving the health of communities in the Southeast area of Los Angeles and Northern Orange County.

OptumCare is committed to creating an environment where physicians focus on what they do best: care for their patients. To do so, OptumCare provides administrative and business support services to both owned and affiliated medical practices which are part of OptumCare. Each medical practice part and their physician employees have complete authority with regards to all medical decision-making and patient care. OptumCare's support services do not interfere with or control the practice of medicine by the medical practices or any of their physicians.

Diversity creates a healthier atmosphere: OptumCare is an Equal Employment Opportunity/Affirmative Action employers 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.

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

Job Keywords: Healthcare Claims, Medical Claims, Managed Care, compliance, Health Plan, Manager, Supervisor, PowerPoint, Excel, Word, La Palma, CA, California

With offices around the world, UnitedHealth Group's headquarters are located in the Minneapolis metropolitan area.

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