UCare

Claims UAT and Quality Audit Manager

Employer
UCare
Location
Minneapolis, Minnesota
Posted
Jan 27, 2022
Closes
Apr 23, 2022
Ref
2794
Category
Healthcare
Employment Status
Full Time
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 600,000 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.

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

ABOUT UCARE

UCare offers Medicare, Medicaid, Individual and Family health plans - powered by the hardest working people in the industry. Our people powered teams de-complicate, advocate and always go the extra mile to help our members. We serve with integrity, compassion and commitment to do right by members, providers and government partners. Above all, we come to work excited to provide members a path for the best health of their lives.

WORKING AT UCARE

Working at UCare is more than 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. Employees join UCare and stay because of the opportunity to have a purpose-driven job.

Our strong culture has established UCare as a Star Tribune Top 150 Workplace for 12 consecutive years since the awards program began. It's a culture that embraces innovative ideas, strategic partnerships, and exemplary customer and provider experiences. Working at UCare is being a part of a people powered team dedicated to making a real difference in the lives of our members and communities.

CLAIMS UAT & QUALITY AUDIT MANAGER

Work Location: Work from Home, standard or hybrid

The health and safety of our employees, members, providers, and our community is our highest priority. Therefore, all new employees are expected to be fully vaccinated against COVID-19 prior to starting at UCare, subject to limited exceptions such as for a sincerely held religious belief or for medical reasons.

Position Description

This position is responsible to oversee the daily operations and deliverables of the Quality Control Team, including: UAT Testing of new or revised HealthRules configuration; monitor and report quality measures, standards, and results; and oversight of all claims auditing functions. Develop, utilize, and manage comprehensive test scenarios, auditing, UAT methodologies and tools. Ensure quality efforts that support organizational and departmental strategic plans, regulatory directives, operational initiatives, and health care reforms meet deadlines and deliver agreed upon functionality. Develop, implement, and maintain infrastructure for quality measurements and reporting in the Configuration & Claims Operations (CCO) department driving continual improvement to methods and processes. Plan, develop, and execute on strategies for UAT testing and claims auditing.

• Provide end-to-end oversight and management (people, process, technology) of claims auditing, UAT of HealthRules configuration and other CCO application related changes or upgrades, quality measurement and reporting.

• Establish a repeatable and reliable approach to develop and maintain key departmental metrics, ensuring that data is easily consumable and accessible.

• Manage and provide oversight of UAT related functions for UAT testing of new or revised HealthRules configuration including but not limited to benefit, pricing, account and member, claims and post-production audits.

• Manage and provide oversight of all claims auditing functions including standard daily, target, project, regulatory, and training.

• Establish, maintain, communicate, and continually evaluate individual performance standards.

• Develop, implement, and provide oversight to maintain policies, procedures, work instructions, and other documentation in support of departmental needs. Monitor workflow and staff performance to continuously improve CCO quality standards.

• Manage staff to ensure key objectives are delivered on time, within quality parameters and achieve agreed upon objectives.

• Collaborate and lead initiatives partnering with other Configuration & Claims Operations Leaders, focusing on improving the quality of work results across all functions of work.

• Participate in the planning and execution of department and portfolio projects.

• Other projects and duties, as assigned.

Education

Bachelor's degree in business or related field preferred; demonstrated work experience may be considered in lieu of degree.

Required Experience

Five years of supervisory/managerial experience. Five years of healthplan operations experience. Project management experience. Experience with business process improvement and UAT strategy.

Preferred Experience

Experience as a Quality Assurance, Systems or Business Analyst. System knowledge of claims adjudication applications. System knowledge of workflow applications.

THE UCARE DIFFERENCE

The UCare difference is our people power - employees actively working on the behalf of our members to get them access to the health care they need. We value and respect each individual's ideas and contributions, and provide the freedom to grow both personally and professionally. We are centrally located, and offer onsite education, equipment and wellness resources, and a myriad of volunteer activities. If you're looking for an inclusive environment that celebrates your people power, 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.

JOB POST DATE: 1/26/2022

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