Associate Director, Claim Validation - Remote

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives?

Join us in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together. The Associate Director will lead operational processes and delivery for pre-pay and post-pay claims review services supporting multiple Commercial clients, with direct oversight of 8-10 leaders and indirect oversight of their teams including indirect oversight and support for global operations. The role is accountable for meeting client service level agreements (SLAs), managing inventory and capacity, workforce modeling, maintaining quality, and improving productivity, efficiency, and process consistency.

Responsibilities include setting operational expectations, managing performance, removing barriers, and leading projects and continuous improvement initiatives to strengthen execution and reduce unit costs. The Associate Director will partner with Client Associate Directors, Operations Managers, Team Leads, Clinical and Non-Clinical resources, Business Analysts, and Matrix Partners to standardize workflows, align resources, and meet contractual and regulatory requirements. The role retains accountability for financial and non-financial results, including budgets, SG&A cost goals, and approximately $1B in Commercial client savings through Fraud, Waste, and Error recoveries, while engaging regularly with clients and internal stakeholders to address operational priorities and sustain results.
You'll enjoy the flexibility to work remotely
* from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

• Provide direct leadership to 8-10 operational leaders and indirect oversight of their teams, setting clear expectations and driving accountability for operational results
• Manage Inventory, SLAs, productivity, through capacity analysis planning and quality control
• As client growth and organizational demand dictates, ADs will also lead operational readiness for the implementation of one or more large, multi-year contracts, with coordination and quality assurance for all services delivered as well as ongoing optimization opportunity identification and development
• Identify and manage system issues, and ensuring data integrity, security controls and process adherence
• Work with matrix partners to manage client contract obligations and deliverables
• Achieve savings, revenue and IOI targets by effectively planning staffing and staff responsibilities as well as identifying efficiency opportunities - both technical and process driven
• Drive favorable algorithm outcomes by partnering with Research & Development to provide policy expertise which will drive and optimize savings and revenue
• Ensure adherence to state and federal compliance policies, reimbursement policies and contract compliance
• Identify & remove operational barriers. Conduct deep dive program reviews with relevant internal and/or external stakeholders to identify opportunities for continuous improvement
• Partner with offshore operations to tightly integrate business practices and deliver services at a more affordable rate, both internally and with our Matrix business partners
• Identify and/or secure resources (e.g., funding; staffing; system…