Health Care that Starts with You!

Join a truly mission-driven organization! Independent, nonprofit UCare is recognized as one of the Minnesota's leading health plans. We provide more than 225,000 members across Minnesota and western Wisconsin with the health coverage plans and services they need to maintain and improve their health. The innovative coverage we create makes a difference for Medicare-eligible individuals, individuals and families enrolled in Minnesota Health Care Programs, such as MinnesotaCare and Medical Assistance, and disabled adults with special health care needs. UCare is growing in size, membership, products, geographic coverage, and employees. We're an organization that's going places. Be part of a team that cares about you, be part of UCare.

ABOUT UCARE

At UCare, we deliver high-quality health coverage and services to help members of all ages maintain and improve their health. It's a big job that takes innovative ideas, strategic partnerships, and a commitment to doing the right thing. Above all, it takes a compassionate team that is dedicated to making a real difference in the lives of our members and our communities.

WORKING AT UCARE

Working at UCare is more than just a career; it's a mission. A mission that defines us as professionals, unites us as an organization, and shapes how we interact with our members and each other. Our values of integrity, community, quality, flexibility, and respect permeate every aspect of our organization - from who we are and how we act, to what we do and how we do it. We owe our continued success to our employees who proudly embody our mission and values in everything they do.

CONFIGURATION & CLAIMS OPERATIONS ASSOCIATE DIRECTOR - TECHNICAL

Position Description

This position is responsible to oversee technical claims editing, reporting and quality assurance, EDI, and technical claims functions.  Develop and implement process improvements to improve the quality and productivity of claims editing, testing and EDI work streams across the claims payment continuum. Actively manage relationships with UCare's EDI, EOP, and EOB vendor relationships. Participate as a member on the Minnesota AUC Operations Committee to ensure UCare's input is provided on policy and procedure changes and that UCare maintains compliance with agreed upon operating standards.

·Accountable for the oversight of EDI business processes, transactions and vendors. Partner with EDI Business and Technical Owners. Ensure compliance with regulatory requirements.

·Oversee Optum-purchased software and services (e.g., CES, Facility Editor, AIM, Subrogation, etc.) including business rules for set-up to insure prompt, accurate claims payment and recovery.

·Oversee the audit, data migration and quality assurance processes across all configuration, provider enrollment and claims teams and functions.

·Accountable for the development, deployment and ongoing optimization of departmental reporting and training.

·Develop and manage partnerships with IT leaders to align processes and strategies to improve configuration and claims reporting and manage and enhance environments, data migration and quality assurance tools and internal and external data and information sharing.

·Oversee the management of claims support, coordination of benefits, provider appeals and adjustments processes.

·Assist in the development and execution of department plans and actions that are integrated with other departments and support the corporate strategic plan and UCare prioritized projects and initiatives.

·Implement policy/procedure changes as necessary to meet contractual and regulatory requirements.

·Select, train, develop and evaluate staff and leaders to ensure desired performance.  Establish and communicate clear performance standards.

·Maintain a method of prioritizing and reporting workload within the department.

·Other projects and duties as assigned.

Education

Bachelor's degree; Master's Degree preferred. Demonstrated work experience may be considered in lieu of a degree.

Required Experience

Five years of experience with system development and testing.  Vendor relationship management experience. Knowledge of Health Plan Operations.  Experience managing and engaging staff and leaders.

Preferred Experience

Business analysis experience. Project management experience. Process improvement experience.

THE UCARE DIFFERENCE

UCare is proud to be a recognized Star Tribune Top Workplace for the 9th consecutive year. As a part of our collaborative team, you'll experience the rewards that come with helping others and seeing the positive results of your hard work. We value and respect each individual's ideas and contributions, and give you the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, a myriad of volunteer activities, and a number of other rewards. If you're looking for a welcoming environment that celebrates what you have to offer, helps you build on your strengths, and gives you the opportunity to truly make a difference, we invite you to apply.

As an Equal Opportunity/Affirmative Action Employer, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.

Rewards

Enter a highly collaborative environment where people are truly engaged, and feedback is valued. You'll enjoy a competitive salary and benefits, as well as a host of other perks, including a nationally recognized wellness program, and a bright, open, award-winning office space in Northeast Minneapolis just minutes from major freeways and retail centers. At UCare, we welcome and employ a diverse employee group committed to meeting the needs of UCare, our members, and the communities we serve.
www.ucare.org/careers/
EOE/AA