Daniel Payton Email & Phone Number

Houston, Tx, Us

Houston, Texas, United States

Create, control, and improve end-to-end business processes.Partner with project implementation teams regarding process improvement activities.Identify process improvement opportunities and develop solutions using principles of process excellence and related tools.Collaborate across the team and with Optum/UHC Digital programs to ensure shared understanding of opportunities within existing workflows as well as potential ideas for improvement.Utilize continuous improvement tools to carry out basic process enhancements.Ensure tasks are completed on time, within budget and within scope.Maintain process documentation to be utilized by the function being supported.Ability to make decisions; work with minimum guidance; seek guidance on the most complex tasks.Exceptional attention to detail and extremely organized with the ability to manage multiple priorities and meet deadlines.Manage timelines for projects, maintaining visibility on day-to-day activities with project work group throughout the project lifecycle.Obtain needed resources from different functional teams and subject matter experts to implement process solutions and ensure operational readiness success.Coordinate with relevant internal and/or external stakeholders to ensure programs comply with critical organizational and business requirements.Facilitate and moderate meetings to communicate with applicable stakeholders to provide project progress updates regarding objectives, goals, timelines, performance metrics and risks/roadblocks.Analyze data to determine root cause of issue to identify and document trends and create solutions to new capabilities.Solve unique and complex problems with broad impact on the business.Recognizes trends and issues with existing processes and uses continuous improvement best practices to help drive next steps.Works as self-directed.Works on less structured, more complex issues.Serves as a support role .

Houston, Texas, United States

Analyze/research/understand how a claim was processed and why it was denied.Obtain relevant medical records to submit appeals or grievance for additional review, as needed.Leverage appropriate resources to obtain all information relevant to the claim.Identify and obtain additional information needed to make an appropriate determination.Obtain/identify contract language and processes/procedures relevant to the appeal or grievance.Work with applicable business partners to obtain additional information relevant to the claim (e.g., Network Management, Claim, Operations, Enrollment, Subrogation).Determine whether additional appeal or grievance reviews are required (e.g., medical necessity), and whether additional appeal rights are applicable.Determine where specific appeals or grievances should be reviewed/handled, and route to other departments as appropriate.

Texas, United States

Coordinate and supervise daily /weekly / monthly activities of a 20-25-person team including setting priorities for the team to ensure task completion and performance goals are met.Coordinate work activities with other supervisors, managers, departments, etc.Identify and resolve operational problems using defined processes, expertise and judgment.Provide coaching, feedback and annual performance reviews as well as formal corrective action.Communicate with appropriate parties regarding appeals and grievance issues, implications, and decisions.Analyze and identify trends for all appeals and grievances.Analyze and interpret complex data to identify trends, patterns, and opportunities for the business.Sets team direction, resolves problems, and provides guidance to members of own team.

Texas, United States

Support appeals and grievance operations teams by providing processing expertise.Work closely with resolving analysts and supervisors to improve individual and team quality, technical skill set, and efficiency through coaching and training efforts.Create or update Standard Operating Instructions.Letter testing and development as needed.Collaborate effectively with business partners, peers, and other operational members to ensure business Performance Guarantees are met.Facilitate individual coaching sessions as requested by management or resolving analyst.Facilitate or support group training sessions a requested by management.

Texas, United States

Provide expertise or general claims support by reviewing, researching, investigating, negotiating, processing, and adjusting claims.Analyze and identifies trends and provides reports as necessary.Constantly meet established productivity, schedule adherence, and quality standards.Experience Medicare & Retirement Claim and or Community and State Claim processing.Consistently meet established productivity, schedule adherence, and quality standards.Provide excellent customer service .Extensive work experience within own function.

Texas, United States

Clearly communicates claims status, payment methodology, contract terms, procedures, etc. to customer. Identifies trends in errors or inquiries and reports these to appropriate personnel Informs and assists callers with the claim appeals process, if necessary.