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Senior Vice President - Core Claim Strategy and Operations - UHC Core Operations

Company: UnitedHealth Group
Location: San Jose
Posted on: March 20, 2023

Job Description:

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us and start doing your life's best work.(sm)

The Core Claim Strategy & Operations executive leads the vision and strategic direction with accountability for the operational results for a team exceeding 25,000 domestic and global dedicated professionals. This role has primary responsibility for strategy formulation and management, overseeing strategic planning, along with development of the business plan that will help position us for future growth and transformation. This leader will be focused on putting employees first, ensuring our Operation delivers flawlessly on its commitments to our members while focusing on improving member and provider experience, simplifying business processes and technology innovation for the 50M+ members UHC serves, which includes over 600M+ claims processed each year. This executive role leads and is accountable for the following areas of UHC Core Operations:

  • Employer & Individual Claim & Benefit Installation which has end-to-end responsibility for the development and execution of our claim strategy and roadmap for Employer & Individual (E&I) claim operations, benefit configuration change readiness and testing, business technology and business controls. Responsible for claim processing, adjustments, appeals & grievances and benefit installation for all E&I markets
  • Government Core Claim which has end-to-end responsibility for our Community and State (C&S) and Medicare and Retirement (M&R) member population across the claim lifecycle. A core responsibility includes ensuring adherence to Federal, State and Exchange requirements and audit performance. Drives enterprise revenue by amplifying industry-leading Star Ratings performance for appeal timeliness and fairness as well as HRA and CTM Star Rating measures
  • Strategic Claim Capability which has responsibility for defining future claim business process and technology capabilities needed to support new claim adjudication and payment strategy to include cost estimator tools, real-time payments, virtual payment cards, etc.

    You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

    Primary Responsibilities:

    • Understand and anticipate the behaviors and needs of consumers and internal customers across the lines of business (E&I, M&R, C&S, UHC Ops Consumer Service, IFP)
    • Leads with a passion centered around employee engagement and experience, with a focus to simplify both process and tools for our employees
    • Serves as an effective Enterprise leader with an emphasis on claim strategies across UHG (Payment Integrity, Enterprise Clinical, etc.) and the experience Core Operations provides
    • Understands the external market, benchmarking future needs and strategy against industry requirements -
    • Proactively initiates and drives change in processes, tools and capabilities that increase operational efficiency and effectiveness while concurrently improving the consumer experience and complying with regulatory requirements
    • Shapes future technology strategies as we advance automation, AI, ML, etc. to innovate how we work
    • Leads and mentors a leadership team focused on core operations and employee engagement that is responsible for operational planning, execution and implementation related to end-to-end claim operation and needs
    • Collaborates with key business partners across UHC including Network, Clinical Services, Optum and Technology to understand products, services and regulatory requirements; proactively communicates and drives strategic and operational plans to achieve the required operational results
    • Consistently achieves key performance metrics, including consumer satisfaction, compliance, employee engagement and financial objectives
    • Builds and fosters relationships within a matrix organizational structure to proactively resolve issues, drive efficiencies and champion the consumerism strategy
    • Fosters a culture of accountability that emphasizes people and performance management, coaching and development and employee engagement

      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 or equivalent experience
      • 15+ years of increasingly responsible operations leadership experience
      • Experience with strategic, consumer-centric initiative development and implementation, including operating policies and procedures and work process improvements
      • Demonstrated operationally minded leader with financial acumen and ability to articulate ROI and business value
      • Demonstrated success in managing large and geographically dispersed operation

        Preferred Qualifications:

        • MBA -
        • Solid verbal, written, interpersonal and presentation skills
        • Proven ability to collaborate and influence internal and external business partners
        • Proven track of building and fostering relationships at all levels of the organization
        • Demonstrated ability to lead and develop leaders
        • Track record of driving high employee engagement and lowering attrition while building a diverse and inclusive workforce

          Careers with UnitedHealthcare. Work with a Fortune 5 organization that's serving millions of people as we transform health care with bold ideas. Bring your energy for driving change for the better. Help us improve health access and outcomes for everyone, as we work to advance health equity, connecting people with the care they need to feel their best. As an industry leader, our commitment to improving lives is second to none.

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

          California, Colorado, Connecticut, Nevada, New York, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New York, Rhode Island or Washington residents is $325,000 to $400,000. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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. - -

Keywords: UnitedHealth Group, San Jose , Senior Vice President - Core Claim Strategy and Operations - UHC Core Operations, Executive , San Jose, California

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