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The Director - Automations & Efficiencies is responsible for leading strategic initiatives aimed at enhancing operational effectiveness through innovative automation solutions within UMR Medical Third-Party Administrator (TPA) 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'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some 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 Robotic Process Automation (RPA), AI, Machine Learning, 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

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:

• 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

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). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $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.

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.  

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.