Payment Integrity COB Data Analyst

Payment Integrity COB Data Analyst

This job is no longer open

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. 

As a Payment Integrity Data Analyst you will be responsible for building and documenting targeted algorithms, conducting analyses of health care membership and cost data, and assuring data quality. As a PI DA you will partner with stakeholders to understand data requirements and develop algorithms for inventory creation, dashboards, data visualizations, decision aids, and business case analysis to support the business and underlying client agreements. Documentation includes creating specifications for product or process builds, creating business requirements or process flows, interpreting results, developing actionable insights, and presenting recommendations for business use. Team members use business intelligence, data visualization, query, and analytic software to build solutions, perform analysis, and interpret data. PI DAs contribute their subject matter expertise in the design of analytics and algorithms.

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

Primary Responsibilities:

  • Research and identify areas for potential non-clinical medical cost improvements and alternative pricing strategies with government and commercial payers
  • Interpret and analyze claims and membership data
  • Lead projects to completion by contributing to database creation, statistical modeling, and financial reports
  • Write complex SQL queries to execute against large healthcare payer data sets
  • Create and update automated database processes
  • Analyze reporting tools utilized by internal customer groups
  • Use logical, detail-oriented thought process to breakdown complex problems into individual root causes
  • Identify and refine criteria to successfully increase efficiency of algorithm logic
  • Contribute to analytic opportunities that may include proof of concept, functional testing, determination of yield, time to complete, and financial impact
  • Explore potential trends identified by matrix business partners
  • Use business requirements for process automation, analytic development, strategic reporting, and system navigation
  • Execute standalone production processes
  • Triage anomalies observed with production processes

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.

Years of post-high school education can be substituted/is equivalent to years of experience.

Required Qualifications:

  • 2+ years of experience in a corporate setting
  • 2+ years of experience performing data analytics, including identifying trends in large data sets
  • 2+ years of experience reading and writing complex SQL statements/queries
  • 2+ years of experience with MS Excel, including pivot tables, formulas, calculations, charts, graphs, etc.
  • Experience working from business requirements documents 

Preferred Qualifications:

  • Experience in COB (Coordination of Benefits) auditing
  • Experience in Medicare reimbursement methodology
  • Knowledge of NAIC (National Association of Insurance Commissioners) guidelines

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

California, Colorado, Connecticut, Hawaii, Nevada, New York, New Jersey, Rhode Island, or Washington Residents Only: The salary range for California, Colorado, Connecticut, Nevada, New Jersey, New York, Rhode Island or Washington residents is $70,200 to $137,800 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.

External Candidate Application

Internal Employee Application

This job is no longer open
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