Deputy Manager – Claims
Company: Optum (UnitedHealth Group)
Location: Hyderabad, Telangana, India
Requisition Number: 2364328
Job Category: Claims
Employment Type: Exempt (Full-time)
Role Overview
The Deputy Manager – Claims is responsible for overseeing US healthcare claims operations, particularly in Behavioral Health claim adjudication and audit processes. The role involves managing escalations, ensuring process compliance, driving operational efficiency, and supporting continuous improvement initiatives.
This position also plays a key role in quality assurance, workforce planning, and process optimization within a healthcare claims environment.
Key Responsibilities
1. Claims Operations & Escalation Management
Handle escalated customer and stakeholder issues and ensure timely resolution.
Act as the point of contact for critical operational escalations.
Ensure adherence to service level agreements (SLAs).
2. Process Compliance & Quality Assurance
Maintain accuracy and quality of claims processing activities.
Own responsibility for internal and external audit requirements.
Ensure compliance with company policies, procedures, and healthcare regulations.
Monitor quality metrics and audit sample strategies.
3. Process Improvement & Optimization
Identify opportunities for:
Cost reduction
Automation
Productivity improvement
Cross-utilization of resources
Drive Lean and Six Sigma-based process improvements.
Perform root cause analysis to resolve operational issues.
4. Data Analysis & Reporting
Maintain accurate operational data and reports.
Use MS Excel and PowerPoint for reporting and analysis.
Support data-driven decision-making and performance tracking.
5. Workforce & Capacity Planning
Analyze workload trends and forecast capacity requirements.
Align staffing and resource allocation to operational demand.
Support efficient workforce utilization.
6. Stakeholder Collaboration
Collaborate with internal teams on special projects.
Communicate effectively with customers, stakeholders, and internal teams.
Support cross-functional initiatives and business priorities.
7. Continuous Learning & Business Awareness
Stay updated on US healthcare industry changes.
Understand behavioral health claims processes and policies.
Continuously improve domain knowledge and operational expertise.
Required Qualifications
Experience
Minimum 5+ years of experience in US healthcare claims processing
Strong experience in:
Behavioral health claim adjudication
Claims audit processes
Technical & Domain Knowledge
Strong understanding of:
Copay, coinsurance, deductible
Coordination of benefits (COB)
In-network / out-of-network claims
CPT and HCPCS coding
Knowledge of US healthcare systems and regulations
Analytical & Process Skills
Strong logical and analytical thinking
Experience in:
Six Sigma methodologies (preferred)
Lean principles (preferred)
Root cause analysis
Strong understanding of quality metrics and audit strategies
Tools & Reporting
Advanced proficiency in:
Microsoft Excel
Microsoft PowerPoint
Soft Skills
Strong verbal and written communication
Ability to handle multiple priorities
Strong probing and problem-solving skills
Ability to work under pressure and meet SLAs
Attention to detail and accuracy
Key Competencies
Operational leadership in claims processing
Data-driven decision-making
Process optimization mindset
Stakeholder management
Quality and compliance focus
Work Environment
Office-based healthcare operations environment
High-volume, SLA-driven claims processing setting
No travel required
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