Claims Supervisor - San Juan, PR

Employment Type

: Full-Time


: Accounting

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.(sm)

Positions in this function are responsible for supervising expertise and general claims support to teams in reviewing, researching, investigating, negotiating, processing and adjusting claims. Authorizes the appropriate payment or refers claims to investigators for further review. Conducts data entry and re-work as required.

Primary Responsibilities:

  • Coordinate and supervise daily/weekly/monthly activities of a team members including setting priorities for the team to ensure task completion and performance goals are met
  • Respond to claims appeals
  • Identify and resolve operational problems using defined processes, expertise and judgment
  • Provide coaching, feedback and annual performance reviews as well as formal corrective action
  • Coordinates, supervises and is accountable for the daily activities of business support, technical or production team or unit
  • Manage inventory and performance to business metrics
  • Submit P&P update requests
  • Provide expertise or general claims support to team in reviewing, researching, investigating, negotiating, processing and adjusting claims
  • Identify and resolve operational problems using defined processes, expertise and judgment
  • Conduct analysis and identify trends and provide reports as necessary
  • Support team employee engagement and continually working to meet and/or improve vital signs results
  • Work / Lead special projects as assigned
  • Back-up for other supervisors or manager as needed
  • Identify and resolve claims processing errors/issues and trends as needed
  • Communicate and collaborate with internal and external business partners
  • Document and communicate status of claims to stakeholders as needed
  • Achieve applicable performance metrics (productivity, quality, TAT, utilization)

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.

Required Qualifications:

  • Associates Degree or equivalent credits approved
  • 2+ years’ experience working in a leadership role (supervision)
  • 1+ years’ experience working in Healthcare Insurance Industry
  • Proficient in MS Office with strong computer skills (e.g. multiple systems experience, keyboarding skills, Microsoft word, Power Point)
  • Proficient in verbal and written English skills
Preferred Qualifications:
  • Experience analyzing and identifying trends
  • Ability to interpret electronic data and apply to health care claim processing
  • Ability to drive performance management
  • Inventory management experience
  • Experience working with a Claims management system

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

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

Job Keywords: Claims Supervisor, Customer Service Supervisor, Claims Leadership, San Juan, Puerto Rico, PR

Job Requirements:

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