Out of Network Dispute Manager

** Requisition number:
** 2380453

** Job category:
** Claims

_This position is National Remote. You'll enjoy the flexibility to telecommute
* from anywhere within the U.S. as you take on some tough challenges._

At United Healthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start  
** Caring. Connecting. Growing together.*
* You'll join a high caliber team where you're assisting, educating, problem-solving and resolving tenuous situations to the best possible outcomes. Bring your people skills, emotional strength and attention to detail. In return we offer the latest tools and most intensive training program in the industry. Get ready to start doing your life's best work.

The Out of Network (OON) Dispute Resolution team is responsible for end to end resolution of regulated OON disputes/arbitrations across UHC commercial lines of business on a variety of platforms. This team has expanded significantly as a result of the No Surprises Act section of the federal Consolidated Appropriations Act.

As a key member of the OON Dispute Resolution Team, the business manager is responsible for the day to day functions of UHC's mediation programs which are mandated by state and federal statutes. The manager is also responsible for the development and implementation of process changes due to strategic initiative shifts or regulatory requirements. This position requires extensive verbal and written communication with internal partners as well as regulators, arbitrators, and provider representatives.

The manager collaborates across functions to develop strategy related to:

-Network/OON Programs

-Health Care Economics

-Legal, Compliance and Regulatory Affairs (LCRA)

-Regulatory Implementation

This position is full time. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime.

We offer weeks of on-the-job training. The hours of the training will be aligned with your schedule during normal business hours.

*
* Primary Responsibilities:

*
* + Sets team direction, resolves problems and provides guidance to team members

+ Oversees work activities of Supervisors, Subject Matter Experts, Team Leads, Negotiation Analysts, and global and domestic OON Dispute Analysts

+ Implements departmental plans and priorities to address business and operational challenges

+ Influences or provides input to forecasting and planning activities

+ Responsible to maintain existing policies, procedures and best practices of the program

+ Implement process and policy revisions as needed to ensure continued compliance with applicable laws and regulations

+ Execute implementation changes in support of state and federal surprise billing requirements

+ Analyze, Manage and Communicate Regulatory Information

+ Perform critical and objective review of regulatory information (e.g., obtain/interpret/analyze impact on the business)

+ Determine whether business processes are consistent/compliant with applicable regulatory requirements, and take appropriate action as needed (e.g., coordinate with business functions, complete applicable filings/attestations)

+ Collaborate with business partners to review, analyze and oversee/coordinate applicable implementation project plans from a regulatory perspective

+ Manage/monitor implementation to ensure that corrective actions and compliance plans are properly implemented, in collaboration with applicable business partners (e.g., Compliance, functional areas)

+ Utilize appropriate tools and processes to track regulatory compliance (e.g., metrics, advocacy results, fines, legal findings)

+ Collaborate with applicable stakeholders to analyze arbitration results, identify needed process modifications, recommend adjustments to strategy

+ Develop/manage relationships with internal and external stakeholders to maintain ongoing influence on regulated Out of Network disputes

+ Advocate with internal business partners to drive compliance with established laws/regulations

+ Negotiate with regulators on a variety of regulatory matters (e.g., fines, corrective actions)

+ Collaborate with internal business partners to drive achievement of regulators' expectations

+ Demonstrate Understanding of Applicable Business Strategies, Structures, Processes and Regulatory Requirements

+ Navigate/collaborate effectively across the business/segment in a matrix environment, identifying and leveraging key contacts

+ Leverage applicable tools and resources to obtain and store required business data/ information (e.g., intranet, SharePoints, websites, regulatory tracking tools)

+ Demonstrate understanding of the health care industry and marketplace (e.g.,…