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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
F&A SIU Investigations Deputy Manager for OGA PH. The manager will support the team in terms of governance on operations and rigor in keeping quality and production at goal. The manager will be working with different teams to ensure that training, hiring, and projects needs are met. The team performs investigative work, check on billed charges by flagged provider, set up cases, check medical records and do patient interviews meant to help investigators gather basic information and is used to support cases that may go to legal proceedings. Decisions are made based on medical records reviewed by the coding team.
Spans & Layers: With:1 Deputy Manager to 84 Frontline / Without 1 Deputy Manager to 169 Frontline
Metrics: QA at 95%, 7.15 CPH
Demand- Lead team of 75 FTE with the below volumes:
- Team volume 205,585 Cases /month, individual volume 1216 Cases /month
- Savings/Revenue/IOI driven by this role: Not specified for Fraud and Abuse 8+4
- actual vs forecast: 0 vs 1
Primary Responsibility:
- Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so
Required Qualifications:
- College Graduate
- Any Course will do / Medical Allied
- 5+ years of experience as a Operations Manager in BPO
- 2+ years of experience in Healthcare account
- Ability to work onsite
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.
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