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UnitedHealth Group is hiring a Medical Claims Manager!


Medical Claims Manager – UHG Global – Tampa, FL (816568)

Position Description

Our claims operations, including our Medical Claims Manager – UHG Global – Tampa, FL, are the focal point of handling information about services patients receive and the way those services get paid. It’s complex, detailed work. It’s fast paced challenge. It’s a job that calls on you to be thoughtful, resourceful, team – driven and customer – focused. To put it mildly, there is never a dull moment.

Primary Responsibilities: 

  • Serves as a key resource on complex and / or critical issues
  • Translates highly complex concepts in ways that can be understood by a variety of audiences
  • Documents, communicates, and clearly articulates a vision and expectations of what is needed to correct processes
  • Anticipates customer needs and proactively develops solutions to meet them.
  • Solves complex problems and develops innovative solutions
  • Reviews work performed by others and provides recommendations for improvement
  • Leads functional workgroups to achieve key business objectives
  • Willingness to dig in and do research to learn more
  • Develops and presents progress updates to applicable stakeholders tailoring the communication to the audience.
  • Guides testing and validation efforts of identified/implemented solutions
  • Measures impact of solution and monitors post deployment
  • Generally work is self – directed and not prescribed

Required Qualifications:

  • High School Diploma / GED (or higher)
  • 2 + Supervisory or Management experience
  • 3+ years of processing Medical Claims experience
  • 3+ years of experience in business analysis collecting, analyzing, and presenting data and recommendations to management
  • 3+ years of quality and / or process improvement experience, including ability to evaluate end to end business processes, perform root cause analysis and ability to define and implement remediation actions

Preferred Qualifications:

  • Lean process improvement or six sigma qualifications / experience
  • Agile product owner experience
  • 3+ years of COSMOS Claims experience, including knowledge of CPW and COSMOS Claim Operations processes
  • International claims experience
  • Proficient working with Microsoft PowerPoint (ability to create and edit presentations) and Microsoft Excel (ability to create pivot tables, utilize formulas)
  • Background working with technology partners

Soft Skills:

  • Possesses excellent verbal and written communication skills; ability to speak clearly and concisely, as well as ability to understand and interpret information from others
  • Self – starter who can work effectively with little supervision

Careers at UnitedHealthcare Employer & Individual. We all want to make a difference with the work we do. Sometimes we’re presented with an opportunity to make a difference on a scale we couldn’t imagine. Here, you get that opportunity every day. As a member of one of our elite teams, you’ll provide the ideas and solutions that help nearly 25 million customers live healthier lives. You’ll help write the next chapter in the history of healthcare. And you’ll find a wealth of open doors and career paths that will take you as far as you want to go. Go further. This is 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.


Keywords: Medical Claims, UHG, UnitedHealth Group, Tampa, FL, business analysis, process improvement, root cause analysis, remediation coordination, agile, COSMOS



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