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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

The primary responsibilities include evaluating data to and from our EDPS database utilizing SQL. This person will need to identify gaps in processing and be able to discern where remediation should take place as well as document and illustrate deficiencies to other teams and / or customers.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Adhoc reporting, there will be times where management will notice a spike in a number in the system, this analyst will need to be comfortable navigating SQL tables to find metrics to determine the source of the concern
• Work independently to evaluate trending metrics and autonomous to evaluate where additional research is needed so we can provide the best outcomes for our clients in terms of data acceptance at CMS
• Quality reporting, analysis and audits and for developing plans and programs to support continuous quality improvement using applicable tools
• Assist in special projects as needed. For example a client may have data failing and Optum may need to come up with a creative way to work around this until a fix can be implemented
• Solid analytical skills in evaluating 837 EDI response files and required remediation efforts
• Host and manage external client meetings and expectations

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

One year of post-high school education can be substituted/is equivalent to one year of experience.

Required Qualifications:     

• 3+ years of direct client-facing experience/engagement
• 2+ years of healthcare EDI experience on 837 claims submission and response processing
• 2+ years of PL/SQL experience including the ability to query
• 2+ years of experience with process improvement, workflow, benchmarking and / or evaluation of business processes
• Rundeck and Talend experience
• Deep expert knowledge on CMS regulations
• Data analysis and problem-solving skills
• Highly polished communication skills with ability to host client meetings
• Demonstrated issue management and resolution skills
• Proven advanced leadership abilities to work across internal and external business partners

Preferred Qualifications:     

• Bachelor’s degree
• 1+ years of UNIX experience
• Exposure to clinical healthcare coding terminology
• Medicare Advantage risk adjustment experience 
• Intermediate level of proficiency with PC based software programs and automated
• Database Management Systems (Excel, Access, PowerPoint)
• ITIL or AGILE business process experience 
• Healthcare Payment systems experience 
• Ability to create test scenarios that match real world situations to proactively ensure optimal production data processing
• Possess a solid understanding of the healthcare EDI business flow to create viable testing scenarios and technical ability to run SQL scripts to perform said test scenarios
• Excellent communication, time/project management, problem solving, organizational, and analytical skills
• Working knowledge of relational databases and database structures
• Independent thinker and problem solver with an analytical mind and the ability to solve complex data and workflow issues

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island, or Washington Residents Only: The salary range for California/Colorado/Connecticut/Nevada/New Jersey/New York/Rhode Island/Washington residents is $85,000 to $167,300 annually. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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. 

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.