Operations Manager (Payment Integrity) - San Juan, PR

Requisition Number: 2373173
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
The Manager of Administrative Coding is part of the leadership team overseeing Optum's Behavioral Payment Integrity (PNI) Operations; specific to Fraud, Waste, Abuse, & Error (FWAE) investigations. This position is responsible for the strategic direction and execution of the Optum Behavioral administrative coding review team.
Primary Responsibilities:

• Lead and develop a team responsible for resolving complex provider inquiries, escalations, and Payment Integrity operational issues
• Establish and maintain trusted relationships with senior internal and external stakeholders, including UHN, UHC Payment Integrity, Network Management, and Provider Relations partners
• Drive resolution of high-priority escalations through collaboration with Operations, Analytics, Reporting, Medical Directors, Compliance, and Legal partners as appropriate
• Facilitate executive-level meetings, discussions, and Q&A sessions with leadership stakeholders
• Monitor production, quality, turnaround time, service-level agreements, and operational performance metrics to ensure successful delivery of business objectives
• Prioritize work queues and implement contingency plans when operational targets are at risk
• Lead root cause analysis and corrective action planning to address recurring operational issues and improve performance outcomes
• Analyze trends, performance data, and operational metrics to identify opportunities for process improvements, efficiency gains, and risk mitigation
• Partner with business leaders to anticipate future operational needs and support workforce planning strategies
• Develop executive presentations, business reviews, and leadership materials that communicate operational performance, risks, opportunities, and strategic recommendations
• Influence and drive alignment across multiple business functions without direct authority
• Supervise, coach, mentor, and develop a team, fostering a culture of accountability, engagement, and continuous improvement
• Partner with global and enterprise stakeholders to support strategic initiatives, operational objectives, and business growth opportunities

***ENGLISH PROFICIENCY ASSESSMENT WILL BE REQUIRED AFTER APPLICATION***
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:

• 3+ years of experience in provider-facing, client-facing, or healthcare operations leadership roles
• 2+ years of people management experience
• 2+ years of experience utilizing operational metrics, analytics, dashboards, and performance measures to drive business outcomes
• Experience leading operational improvements in a healthcare, claims, or Payment Integrity environment
• Experience working within healthcare compliance and regulatory requirements
• Experience developing business cases, managing projects, and achieving measurable operational or financial results
• Experience partnering with senior leaders and navigating matrixed organizations
• Experience with Fraud Waste & Abuse or Payment Integrity
• Knowledge of healthcare claims platforms and end-to-end claims operations
• Proficiency with Microsoft Office Suite, including Excel, PowerPoint, Word, and Outlook
• Professional proficiency in English
• Demonstrated ability to work a flexible schedule during normal business hours and support occasional overtime or weekend business needs
• Demonstrated ability to manage competing priorities in a fast-paced, high-change environment

Preferred Qualifications:

• Registered Nurse (RN) license
• Certified Coder
• Experience with provider relations, network management, or network contracting practices
• Experience managing budgets and financial performance
• Experience developing and executing growth, operational excellence, or transformation strategies

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
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.
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