Optum · 19 hours ago
Associate Director, Eligibility Configuration - Remote
United States
Full-time
Remote
Lead/Staff, Director/Executive
$113K/yr - $193K/yr
5+ years expOptum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The Associate Director, Eligibility Configuration, is a critical leadership role responsible for setting strategic direction and driving operational excellence across large-scale eligibility and provider attribution processes.
EducationHealth CareMedicalPharmaceutical
Responsibilities
Set strategic direction and execute business plans to achieve organizational goals and operational excellence
Lead and manage a large team of 150+ employees across multiple staffing models, including domestic, offshore, contractors, and transaction-based billing
Provide operational leadership for eligibility configuration across multiple claim and clinical systems, including Facets, IDX, Monarch, EPIC, and Xcelys
Partner with local markets and finance teams to ensure accurate eligibility reconciliation impacting PMPM (Per Member Per Month) payments from payors
Oversee timely loading of eligibility files and ensure any discrepancies are resolved with high accuracy and speed
Engage with external clients to define and maintain eligibility file requirements, ensuring seamless execution of weekly and monthly processes
Drive automation initiatives by enhancing tools and technology in collaboration with multiple technology partners
Reduce single‑resource and platform‑specific dependencies by building cross‑trained teams and increasing role flexibility to ensure continuity, scalability, and operational resilience
Leverage data analytics to interpret trends, proactively identify issues, and implement corrective actions
Collaborate with market operations leads and issue management teams to research and resolve escalated issues promptly
Partner with Provider Data Operations to improve provider and member attribution accuracy
Ensure claim and clinical readiness for delegation changes by the effective date, maintaining compliance and operational integrity
Lead eligibility configuration and implementation for OptumCare growth, expansions, and de‑delegations, ensuring readiness across platforms and markets
Lead eligibility readiness for the California claims migration to Facets, partnering across technology and market teams to maintain stability and compliance
Represent eligibility operations for OptumCare platforms in governance and enterprise forums, ensuring alignment on standards and execution
Qualification
Required
5+ years of leadership experience in healthcare operations
Proven experience in driving operational excellence through process re-engineering and technology integration
Solid understanding of healthcare payor and provider landscapes
Proven ability to collaborate and influence internal and external business partners
Proven success leading matrixed and geographically dispersed teams, including offshore and/or multi market models, while maintaining consistent performance and operational control
Preferred
Experience leading eligibility, member, or enrollment operations in a multi‑payor healthcare environment, including ownership of eligibility configuration, file ingestion, and reconciliation processes
Experience driving operational efficiency and workforce flexibility, including balancing capacity to demand, improving resource utilization, and scaling teams to support growth or change initiatives
Experience leading teams through transformation or scale, including onboarding new payors, markets, or platforms without degradation to quality or timeliness
Demonstrated experience with configuration across multiple claim platforms (e.g., Facets, EPIC, IDX, Monarch, Xcelys) within a multi‑market or scaled operating model
Proven success reducing single‑resource and platform‑specific dependencies by implementing cross‑training, standardized work, and shared ownership models
Proven solid verbal, written, interpersonal, and presentation skills
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Benefits
Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution
Company
Optum
Optum is a healthcare company that provides pharmacy services, health care operations, and population health management. It is a sub-organization of UnitedHealth Group.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
Daniel Castillo
Chief Executive Officer, Optum Care Delivery
J
Jay Green
Chief Financial Officer
Recent News
2025-11-29
2025-11-19
2025-11-07
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