Job Description
Director, Payment Integrity Non-Clinical Vendor Insourcing Leader
Optum is a global healthcare organization that delivers care and 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 diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Our mission is to help people live healthier lives and make the health system work better for everyone.
About the Role:
As a Fortune 5 business, we're one of the world's leading healthcare companies. There are no limits here on the resources you'll have or the challenges you'll encounter. We have been supporting global healthcare systems from Ireland and the UK for more than 20 years, building a dynamic and diverse team of more than 2,100 talented individuals. With a continued record of growth and stability, we're on the constant lookout for fresh talent to join our expanding teams.
Non-Clinical Operations Payment Integrity within Optum Payer Operations is responsible for driving the development and execution of medical cost savings growth for UnitedHealthcare and Commercial client health plans by ensuring payment accuracy to support the enterprise objectives. The Non-Clinical Operations business drives significant medical costs savings from claims received by healthcare providers through all lines of business/health plans in parallel to other operations within Payer Payment Integrity, technology, analytic, and enablement teams.
Key Responsibilities:
- Provide ideation and growth leadership specifically focused on the identification and resolution of Payment Integrity claim leakage through data, analytic, and operational solutions.
- Lead non-clinical leakage detection governance, including claim leakage oversight and business intelligence.
- Take a client-agnostic lens and lead large-scale data, analytic, and utility change within a matrix environment with a focus on claim leakage detection, operational solutions, and associated benefit realization.
- Partner with data and analytic and engineering teams to ensure enabling capabilities are fully aligned, e.g., data acquisition/enablement, analytic modernization, and client-agnostic leakage detection solutions.
- Support the design and functioning of competitive intelligence processes to enable ideation lead generation and external/internal content opportunities.
- Establish data and business controls to ensure growth opportunities are sourced and vetted appropriately prior to development and/or deployment.
You will 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 providing development for other roles you may be interested in.
Required Qualifications:
- Bachelor's degree or commensurate experience.
- Proven experience in leading data, analytic, and technology change within a matrix environment with a focus on operational solutions and benefit realization.
- Proven experience implementing business transformation initiatives from ideation to successful delivery.
- Previous experience in influencing and understanding the necessary and appropriate actions to ensure maximization of financial results and objectives.
- Proven track record in delivering high-value improvement results within a business using data and technology as the key lever.
- Project Management and/or Scrum certifications.
- Extensive experience working with the ideation, development, and deployment of initiatives for in-year and multi-year benefit realization.
- Previous experience working in a highly matrixed organization.
- Strong conceptual and analytical skills.
- Excellent interpersonal skills, ability to work across all functional areas, as well as business partners.
Preferred Qualifications:
- Knowledge of the US Healthcare industry, major healthcare entities, and claims lifecycle.
- Proficiency at a senior management level within a multi-national enterprise with experience of leading 100+ professionals through a technology change cycle.