Senior Business Analyst

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Primary Responsibilities:

• Lead and manage medium to large-scale programs focused on claims platform operations and enhancements
• Oversee configuration and optimization of claims processing systems
• Conduct Root cause analysis on historical claims to map opportunities related to upstream fixes and automation
• Provide SME support to matrix partners while executing data science concepts / Automations
• Identify potential concepts for retrospective and prospective savings while working with production team ranging from correct network contracting, policy reimbursement, medical documentation requirements, industry and federal guidelines Management concepts to deployment
• Ability to distil criteria for data analysis
• Examine, assess, and document business operations and procedures to ensure operational efficiency and excellence
• Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
• Use pertinent data and facts to ideate, identify and solve a range of problems within area of expertise
• Ability to communicate the outcome of this research in a manner suitable for the intended audience
• Ability to build relationships to increase velocity of concept conversion to identifications
• Ability to work with less structured, more complex issues
• Ability to work independently
• Avid knowledge sharer with the ability to mentor junior team members
• Team player with the ability to collaborate across diverse and matrixed teams
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regard to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

• Graduation in any streams
• PMP or Six sigma qualified
• 5+ years of health care experience working with claims data and / or medical codes
• 5+ years of experience working with processing and reviewing medical claims platforms
• 5+ years of experience with medical claims auditing and researching medical claims information from SOP guidelines perspective
• 5+ years of experience using (either UNET/CSP Facets/COSMOS claims platform)
• Experience analyzing large data sets to determine trends / patterns with Excel / Tableau / Power
• BI
• High proficiency in Excel to perform different types of data & Trend Analysis
• Solid understanding of claims systems and configuration.
• Proven excellent communication, leadership, and conflict resolution skills.
• Proficiency in project management tools and Microsoft Office Suite.
• UHG Platform advance Expertise - UNET, COSMOS, CSP Facets, NDB, Core, WOW
• Upstream and downstream process Knowledge

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.