26 Aug
Manager, Focused Claims Review Operations
New York, New york city


OrthoNet is a proud member of the UnitedHeath Group family of companies and a leading orthopedic specialty benefit management company. OrthoNet works with more than 80,000 orthopedic health care providers, including specialists in orthopedic surgery, neurosurgery, podiatry, and physical, occupational, and speech therapy. Our mission is to achieve optimal outcomes for payors, providers, and members in a manner that combines efficient delivery of services, high quality care, and state of the art utilization and cost management tools.


The Manager is responsible to oversee Supervisors and FCR Operations staff in accordance with Department and Company protocols. The Manager has the responsibility for daily direction, utilization, supervision and administration of the FCR Claims Operations team. Additionally, the Manager provides support to the Supervisors related to implementation, training, and development of workflow procedures to improve operational efficiencies


  • Responsible for key employee-related activities, including interviewing, hiring, promotions, performance appraisals, progressive discipline, separations, time and attendance.

  • Accountable to ensure Operations staff are completing work in a timely manner and in accordance with client and departmental requirements.

  • Responsible for creating and maintaining daily, weekly, monthly reports. Analyze and report on staff productivity; use reports to identify trends, allocation of work, etc.

  • Oversees and reports all daily, weekly, and monthly performance metrics.

  • Monitors staff productivity and provides direct coaching and feedback pertaining to performance.

  • Develops and/or facilitate training(s) to staff. Provides guidance related to newly implemented processes, as needed.

  • Collaborates with the Sr. Director on the coordination/implementation of departmental and organizational policies and procedures in addition to workflow procedures.

  • Ensures adherence to all organization and department policies and procedures.

  • In conjunction with the Sr. Claims Business Process Consultant, creates, implements and monitors departmental procedures and protocols.

  • Responsible to ensure all escalated complaints or issues are resolved in a timely manner.

  • All other duties including, but not limited to special projects as assigned


  • Bachelor's Degree and/or minimum 5 years' experience in health care claims management required.

  • A minimum of 3 years of supervisory experience.

  • Health care insurance or managed care experience

  • Excellent team building skills

  • Diplomatic and tactful with professionals at all levels

  • Accustomed to handling sensitive and confidential information

  • Ability to use good judgment and make independent decisions

  • Professional and positive commitment to service delivery

  • Strong attention to detail and organizational skills.

  • Ability to manage multiple tasks, projects and deadlines simultaneously.

  • Excellent written and oral communication skills

  • Excellent interpersonal and communication skills

  • Ability to effectively work under pressure

  • Proficiency in operating computer applications including MS Office Suite (MS Outlook, Word, Excel, and Power Point).

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