UnitedHealthcare
Director - Automations & Efficiencies - UMR - Remote
UnitedHealthcare, Nutterville, Wisconsin, United States
Director - Automations & Efficiencies - UMR - Remote
At UnitedHealthcare, 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. Join us to start Caring. Connecting. Growing together.
The Director - Automations & Efficiencies is responsible for leading strategic initiatives aimed at enhancing operational effectiveness through innovative automation solutions within the UMR Medical Third-Party Administrator environment. The role entails overseeing the identification, development, implementation, and management of automation projects designed to optimize claims processing, provider engagement, compliance, and overall service delivery.
You will enjoy flexibility to work remotely from anywhere within the U.S. as you take on tough challenges.
Primary Responsibilities
Lead the automation strategy to streamline operational processes, reduce manual interventions, enhance accuracy, and improve turnaround times
Oversee and manage end-to-end automation projects involving claims processing, eligibility verification, provider credentialing, adjudication workflows, and payment integrity initiatives
Collaborate with internal stakeholders and technology teams to identify efficiency gaps and develop targeted automation solutions
Evaluate existing operational procedures and implement process improvements leveraging RPA, AI, ML, and other advanced technologies
Establish and monitor performance metrics and KPIs to track automation effectiveness, cost savings, productivity enhancements, and compliance
Provide thought leadership to continuously improve automation capabilities, ensuring alignment with company goals and industry best practices
Manage relationships with automation vendors, technology providers, and consultants to ensure successful project execution
Maintain compliance with regulatory requirements, ensuring all automation processes meet healthcare industry standards and data security protocols
Foster a culture of innovation, efficiency, and continuous improvement within the team and broader organization
Required Qualifications
10+ years of progressive experience in healthcare payer/TPA operations and enterprise automation
5+ years leading cross-functional automation teams and portfolios with ownership of roadmap, budget, and outcomes
Automation and AI expertise: RPA (UiPath, Automation Anywhere/Blue Prism), workflow/BPM (Pega, ServiceNow), intelligent automation (AI/ML, NLP, IDP/OCR); proven implementation of AI-driven solutions at scale in healthcare operations (LLMs/NLP, IDP, predictive models) with model governance and monitoring
Experience with integration/engineering and platform stack: APIs, event/queue-based orchestration, basic scripting (Python/SQL), CI/CD with Git-based SDLC for automations; deep expertise with core payer platforms (IBM mainframe-based), analytics/BI (Power BI/Tableau), modern data platforms (Snowflake/Databricks), and cloud (Azure/AWS)
Proven deep knowledge of healthcare payer operations: claims adjudication and EDI (X12 837/835/270/271/276/277/278), prior authorization, eligibility/enrollment, and provider data management
Built or led an Automation Center of Excellence (standards, controls, reusable components, demand intake, and performance reporting)
Proven exceptional analytical, problem-solving, and decision-making skills; executive-level communication; stakeholder influence; vendor/SLA management; and change management
Preferred Qualifications
Lean Six Sigma (Black Belt or Green Belt), PMP, Prosci/CCMP, and/or RPA platform certifications (UiPath/AA/Blue Prism)
Direct Medical TPA experience in claims adjudication, cost containment/payment integrity, COB/subrogation, and provider network management
Compliance and security fluency: HIPAA/PHI handling, CMS requirements, audit controls, and risk management
Knowledge of interoperability and security frameworks: FHIR/HL7/X12, HITRUST, SOC 2
Experience leading distributed (onshore/offshore) teams and managing managed-services partners
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Benefits and Compensation Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution (all benefits are subject to eligibility requirements). The salary range for this role will be $132,200 to $226,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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The Director - Automations & Efficiencies is responsible for leading strategic initiatives aimed at enhancing operational effectiveness through innovative automation solutions within the UMR Medical Third-Party Administrator environment. The role entails overseeing the identification, development, implementation, and management of automation projects designed to optimize claims processing, provider engagement, compliance, and overall service delivery.
You will enjoy flexibility to work remotely from anywhere within the U.S. as you take on tough challenges.
Primary Responsibilities
Lead the automation strategy to streamline operational processes, reduce manual interventions, enhance accuracy, and improve turnaround times
Oversee and manage end-to-end automation projects involving claims processing, eligibility verification, provider credentialing, adjudication workflows, and payment integrity initiatives
Collaborate with internal stakeholders and technology teams to identify efficiency gaps and develop targeted automation solutions
Evaluate existing operational procedures and implement process improvements leveraging RPA, AI, ML, and other advanced technologies
Establish and monitor performance metrics and KPIs to track automation effectiveness, cost savings, productivity enhancements, and compliance
Provide thought leadership to continuously improve automation capabilities, ensuring alignment with company goals and industry best practices
Manage relationships with automation vendors, technology providers, and consultants to ensure successful project execution
Maintain compliance with regulatory requirements, ensuring all automation processes meet healthcare industry standards and data security protocols
Foster a culture of innovation, efficiency, and continuous improvement within the team and broader organization
Required Qualifications
10+ years of progressive experience in healthcare payer/TPA operations and enterprise automation
5+ years leading cross-functional automation teams and portfolios with ownership of roadmap, budget, and outcomes
Automation and AI expertise: RPA (UiPath, Automation Anywhere/Blue Prism), workflow/BPM (Pega, ServiceNow), intelligent automation (AI/ML, NLP, IDP/OCR); proven implementation of AI-driven solutions at scale in healthcare operations (LLMs/NLP, IDP, predictive models) with model governance and monitoring
Experience with integration/engineering and platform stack: APIs, event/queue-based orchestration, basic scripting (Python/SQL), CI/CD with Git-based SDLC for automations; deep expertise with core payer platforms (IBM mainframe-based), analytics/BI (Power BI/Tableau), modern data platforms (Snowflake/Databricks), and cloud (Azure/AWS)
Proven deep knowledge of healthcare payer operations: claims adjudication and EDI (X12 837/835/270/271/276/277/278), prior authorization, eligibility/enrollment, and provider data management
Built or led an Automation Center of Excellence (standards, controls, reusable components, demand intake, and performance reporting)
Proven exceptional analytical, problem-solving, and decision-making skills; executive-level communication; stakeholder influence; vendor/SLA management; and change management
Preferred Qualifications
Lean Six Sigma (Black Belt or Green Belt), PMP, Prosci/CCMP, and/or RPA platform certifications (UiPath/AA/Blue Prism)
Direct Medical TPA experience in claims adjudication, cost containment/payment integrity, COB/subrogation, and provider network management
Compliance and security fluency: HIPAA/PHI handling, CMS requirements, audit controls, and risk management
Knowledge of interoperability and security frameworks: FHIR/HL7/X12, HITRUST, SOC 2
Experience leading distributed (onshore/offshore) teams and managing managed-services partners
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Benefits and Compensation Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution (all benefits are subject to eligibility requirements). The salary range for this role will be $132,200 to $226,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations. UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
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