[Hiring] Quality Claims Manager @UnitedHealth Group

Role Description

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.

The Manager, Claims Quality leads the day-to-day work of the Claims Quality team and is accountable for quality planning, quality assurance, quality control, and continuous improvement across Medical, Dental, and Pharmacy Claims. The role provides people leadership, directs claims-quality audits and calibrations, monitors quality and operational performance, strengthens governance and controls, coordinates issue remediation, and translates findings into clear actions for operational and senior leaders.

This leader sets team direction, prioritizes work, develops employees, resolves operational and quality issues, and adapts team plans to changing business needs. The role works across Claims Operations, Clinical Quality, Compliance, Program Integrity, Analytics, Training, technology partners, and external claims partners to improve accuracy, reduce risk, maintain audit readiness, and support reliable claims outcomes.

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

We offer 6 weeks of on-the-job training. The hours during training will be 8:00 am to 5:00 pm CST, Monday - Friday. Training will be conducted virtually from your home.

Primary Responsibilities

• Lead and manage the Claims Quality team, including setting priorities, allocating workload, monitoring performance and capacity, coaching employees, supporting development, and ensuring appropriate operational coverage.
• Oversee Claims Quality activities across Medical, Dental, and Pharmacy Claims, including quality audits, sampling, findings, trends, follow-up, and overall audit performance.
• Lead internal and external audit calibration and quality-governance activities, promoting consistent audit methodology, scoring, interpretation, and resolution of identified discrepancies.
• Monitor Claims Quality performance and analyze audit findings, defects, trends, and operational data to identify risks, recurring issues, improvement opportunities, and recommended actions.
• Lead quality issue management and corrective-action activities, including root-cause analysis, remediation planning, escalation, follow-up, and effectiveness monitoring.
• Develop and strengthen operational and quality controls by identifying control gaps, monitoring risks, establishing appropriate oversight, and supporting audit and compliance readiness.
• Oversee Claims Quality reporting and governance, translating quality metrics, audit results, controls, risks, and operational issues into clear recommendations and executive-level information.
• Lead continuous-improvement initiatives to improve claims accuracy, reduce defects and rework, strengthen processes and controls, and improve operational effectiveness.
• Partner cross-functionally with Claims Operations, Clinical Quality, Compliance, Program Integrity, Analytics, Training, technology teams, and external partners to resolve issues and advance Claims Quality objectives.
• Maintain effective quality documentation and knowledge management, including work instructions, process documentation, training resources, audit evidence, and controlled records.
• Addresses special (ad-hoc) projects as appropriate; Performs special project audits and reviews as requested by other departments/regions.

Qualifications

• High School Diploma / GED OR equivalent work experience
• Must be 18 years of age OR older
• 3+ years of healthcare claims experience involving Medical, Dental, Pharmacy, or comparable claims operations
• 2+ years of people-leadership experience, including direct-report management, SME, or formal team-lead responsibility for workload, performance, coaching, development, and coverage
• 2+ years of quality assurance, claims auditing, compliance monitoring, or operational quality experience
• 2+ years of experience leading or supporting claims audits, quality monitoring, calibration, Audit-the-Auditor, error trending, or remediation
• 2+ years of experience identifying quality or operational issues and coordinating root-cause analysis, corrective actions, and follow-up
• 2+ years of experience using performance metrics, audit findings, or operational data to identify trends and recommend actions
• 1+ years of experience working across Operations, Quality, Compliance, Analytics, Clinical, or other cross-functional stakeholders
• Intermediate proficiency with Microsoft Excel, including filtering, sorting, pivot tables, charts, and analysis of structured data
• Proficiency with Microsoft Word, PowerPoint, Teams, and SharePoint
• Ability to work full-time, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm CST. It may be necessary, given the business need, to work occasional overtime

Preferred Qualifications

• Experience managing Claims Quality, healthcare quality, claims audit, or operational quality team
• Experience across more than one claims domain, such as Medical, Dental, or Pharmacy Claims
• Experience supporting government healthcare programs, government contracts, Veterans Affairs programs, or another highly regulated healthcare environment
• Experience developing or maintaining quality dashboards, governance scorecards, control inventories, control matrices, risk registers, or monitoring frameworks
• Experience with ServiceNow, Smartsheet, claims audit platforms, or comparable workflow and issue-management tools
• Experience with process mapping, business requirements, change management, audit readiness, or business continuity planning
• Working knowledge of healthcare claims concepts such as eligibility, provider validation, billing, coding, modifiers, duplicate claims, denials, routing, aging, and payment accuracy
• Lean Six Sigma, or comparable quality, process-improvement, project-management, audit, or healthcare certification

Telecommuting Requirements

• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

Soft Skills

• Demonstrated ability to manage competing priorities, meet deadlines, communicate risk, and maintain accurate documentation

Pay and Benefits

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 401k contribution (all benefits are subject to eligibility requirements). The salary for this role will range from $72,800 to $130,000 annually based on full-time employment.

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.