Out of Network Dispute Manager

You’ll join a high caliber team where you’re assisting, educating, problem-solving and resolving tenuous situations to the best possible outcomes. Bring your people skills, emotional strength and attention to detail. In return we offer the latest tools and most intensive training program in the industry. Get ready to start doing your life’s best work.

The Out of Network (OON) Dispute Resolution team is responsible for end to end resolution of regulated OON disputes/arbitrations across UHC commercial lines of business on a variety of platforms. This team has expanded significantly as a result of the No Surprises Act section of the federal Consolidated Appropriations Act.

As a key member of the OON Dispute Resolution Team, the business manager is responsible for the day to day functions of UHC’s mediation programs which are mandated by state and federal statutes. The manager is also responsible for the development and implementation of process changes due to strategic initiative shifts or regulatory requirements. This position requires extensive verbal and written communication with internal partners as well as regulators, arbitrators, and provider representatives. The manager collaborates across functions to develop strategy related to:

-Network/OON Programs

-Health Care Economics

-Legal, Compliance and Regulatory Affairs (LCRA)

-Regulatory Implementation

This position is full time. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime.

We offer weeks of on-the-job training. The hours of the training will be aligned with your schedule during normal business hours.

Primary Responsibilities:

• Sets team direction, resolves problems and provides guidance to team members
• Oversees work activities of Supervisors, Subject Matter Experts, Team Leads, Negotiation Analysts, and global and domestic OON Dispute Analysts
• Implements departmental plans and priorities to address business and operational challenges
• Influences or provides input to forecasting and planning activities
• Responsible to maintain existing policies, procedures and best practices of the program
• Implement process and policy revisions as needed to ensure continued compliance with applicable laws and regulations
• Execute implementation changes in support of state and federal surprise billing requirements
• Analyze, Manage and Communicate Regulatory Information
• Perform critical and objective review of regulatory information (e.g., obtain/interpret/analyze impact on the business)
• Determine whether business processes are consistent/compliant with applicable regulatory requirements, and take appropriate action as needed (e.g., coordinate with business functions, complete applicable filings/attestations)
• Collaborate with business partners to review, analyze and oversee/coordinate applicable implementation project plans from a regulatory perspective
• Manage/monitor implementation to ensure that corrective actions and compliance plans are properly implemented, in collaboration with applicable business partners (e.g., Compliance, functional areas)
• Utilize appropriate tools and processes to track regulatory compliance (e.g., metrics, advocacy results, fines, legal findings)
• Collaborate with applicable stakeholders to analyze arbitration results, identify needed process modifications, recommend adjustments to strategy
• Develop/manage relationships with internal and external stakeholders to maintain ongoing influence on regulated Out of Network disputes
• Advocate with internal business partners to drive compliance with established laws/regulations
• Negotiate with regulators on a variety of regulatory matters (e.g., fines, corrective actions)
• Collaborate with internal business partners to drive achievement of regulators’ expectations
• Demonstrate Understanding of Applicable Business Strategies, Structures, Processes and Regulatory Requirements
• Navigate/collaborate effectively across the business/segment in a matrix environment, identifying and leveraging key contacts
• Leverage applicable tools and resources to obtain and store required business data/ information (e.g., intranet, SharePoints, websites, regulatory tracking tools)
• Demonstrate understanding of the health care industry and marketplace (e.g., competitors, product offerings/types, political environment)
• Monitor trends in the healthcare industry and identify implications on regulatory matters pertaining to regulated Out of Network disputes
• Maintain awareness of current and emerging trends/changes in the regulated Out of Network disputes environment
• Provide ongoing support/consulting/guidance to business partners to drive compliance with applicable laws and regulations
• Identify business risks related to regulatory matters, and escalate/communicate as necessary
• Manage/consult on regulated Out of Network disputes

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.

• High School Diploma / GED OR equivalent work experience
• Must be 18 years of age OR older
• 3+ years of managerial OR equivalent experience leading a team through coaching, mentoring, and providing feedback
• 2+ years of experience facilitating cross functional teams through process and business changes
• 2+ years of experience utilizing data to influence key decision makers
• 2+ years of experience driving best practices / actions related to quality, productivity and consumer experience
• Demonstrate and apply understanding of UnitedHealth Group’s business (e.g. specific business capabilities, functions, processes and business cycles)
• Intermediate level of proficiency utilizing Microsoft Excel (formulas, pivot tables), Microsoft Word (create and edit documents) Microsoft PowerPoint (create and edit presentations)
• Ability to work full time. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime.

Telecommuting Requirements:

• 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.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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