Senior Healthcare Economics Consultant (medicare Risk Adjustment) - National Remote - Remote Eligible

Caring. Connecting. Growing Together.

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.

As part of the Optum Care National Risk Adjustment Healthcare Economics team, we support Medicare Advantage Care Delivery organizations by ensuring the accuracy and reliability of risk score modeling, and reporting. We are internal analytics partners who provide expertise to our finance, operations, accounting and clinical leads to identify coding gaps, assess opportunity, forecast, and analyze risk. If you eat, breathe, and sleep risk adjustment like we do, then this is the right place for you! If you’re not a risk adjustment expert, but hungry, driven and willing to learn, we will help you become one of the best-in-class experts in the field.

In this role, you will work with large, complex healthcare datasets such as ASMs, claims, CMS files (MMR, MOR, MAO-004), and other supplemental files to monitor, reconcile, analyze, and enhance our risk score reporting processes. You will perform detailed QA and reconciliation on datasets, conduct ad hoc analyses and investigate data quality issues using SQL (SQL server and Snowflake), Excel, and Tableau. You will also contribute to the development of automated processes to track and explain data changes, quantify their impact on risk scores, and identify trends.

This position is ideal for someone with strong SQL skills, a solid understanding of Medicare Advantage Risk Adjustment, and a passion for data driven problem-solving. You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Supporting complex analytic projects by leveraging data from multiple sources (EDS, medical claims, supplemental data) to support Medicare Advantage Risk Adjustment programs, coding accuracy, and clinical health outcomes. Identify opportunities to automate reporting and streamline repetitive tasks
• Designing and documenting quality assurance plans; performing detailed QA on large datasets and resolving data quality issues using tools such as SQL, Excel, and internal dashboards
• Reviewing and optimizing complex SQL code to improve data pipeline efficiency and reporting accuracy
• Conducting ad hoc analyses related to Medicare Risk Adjustment using SQL (SQL Server, Snowflake) and visualizing trends in Excel or Tableau
• Communicating findings to both technical and non-technical stakeholders; integrating feedback and refining analytics to support decision making
• Researching CMS guidelines, policy updates, and healthcare dataset specifications (MMR, MOR, MAO-004) to support model enhancements and impact analysis
• Maintaining and improving key data processes; contributing to internal documentation and knowledge sharing to support team collaboration
• Managing multiple priorities in a dynamic environment with a focus on continuous improvement

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.

Required Qualifications:

• High School Diploma/GED (or higher)
• 3+ years of advanced analytics experience in Economics, Engineering, Statistics, Finance, Health Administration, Mathematics, or related fields
• 3+ years of hands-on SQL programming experience, including data querying, manipulation and transformation, table creation, complex joins across multiple sources, subquery, indexing and summary reporting
• 3+ years of experience with performing robust quality checks on large datasets, identifying root causes and resolving data issues

Preferred Qualifications:

• Bachelor’s Degree; candidates with relevant experience or advanced degrees are also encouraged to apply
• Experience in analyzing, reconciling, and summarizing healthcare administrative data such as medical claims, membership, MMR (Monthly Membership Report), MOR (Model Output Report), and encounter response files (MAO-002, MAO-004)
• Experience in applying Medicare Advantage Risk Adjustment Methodologies such the CMS-HCC model (Hierarchical Condition Category), risk score calculations and/or impact analysis
• Experience transforming analyses into actionable and easy to digest insights
• Experience using AI, Snowflake or other advanced tools to streamline reconciliation and automate reporting processes
• Experience in historical trend analysis and predictive modeling using a statistical approach to improve process rigor and efficiency
• Strong analytical skills in data extraction, manipulation, visualization, and reporting using tools such as SQL, Excel and Tableau
• Advanced Excel skills (sorting, filtering, conditional formatting, pivot table/charts and formulas such as: VLOOKUP, COUNTIFS, INDEX-MATCH, SUMPRODUCT, IF, IFERROR)

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The salary for this role will range from $89,900 to $160,600 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.