Senior Business Analyst - Remote

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.

Optum, the fast-growing part of UnitedHealth Group, is a leading information and technology-enabled health services business. Our teams are dedicated to modernizing the health care system and improving the lives of people and communities.

Serving every dimension of the health system, we work with a diverse set of clients across 150 countries - from those who diagnose and treat patients to those who pay for care, deliver health services, and those who supply the cures. Optum maintains operations across North America, South America, Europe, Asia Pacific, and the Middle East. Our innovative partnerships provide technology and tools that enable unprecedented collaboration and efficiency. As a result, we can tap into valuable health care data to uncover insights and develop strategies for better care at lower costs.

About The Role

Do you believe data can help reshape the future, and you find yourself loving the thrill of diving into challenging work? At UnitedHealth Group, you will find an organization that will recognize those talents, and you will have lots of growth potential. Here, you will be empowered, supported and encouraged to use analytical and continuous improvement methodologies to help change the future of health care. Does the challenge intrigue you?

As a key member of the Risk and Quality Operations (RQO) team, you will play an important role in delivering UnitedHealth Group's mission of helping people live healthier lives. The primary responsibility of this position will be to ensure that a member's risk adjusting claims are evaluated against their coded medical record encounters for the payment year. The Business Ops Specialist will be responsible for processing, evaluating, and validating claims inventory to ensure the Claims Verification process meets the standard as set by the US department of Health & Human Services (HHS) for chart review. As a Business Ops Specialist, you will be challenged to make recommendations as to how performance can be continuously improved.

Careers with Optum offer flexible work arrangements and individuals who live and work in the Republic of Ireland will have the opportunity to split their monthly work hours between our Letterkenny office and telecommuting from a home-based office in a hybrid work model. You'll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities:

1. Track and manage claims verification inventory within the medical record manager (MRM) application.
2. Ensure timely evaluation of claims against charts and address aging inventory and bottlenecks with operational partners.
3. Track and report claim verification data delivery results from Optum Insight's MRM applications to clients.
4. Assist with operational readiness tasks such as reviewing client configurations and establishing processing timelines.
5. Demonstrate understanding of standard operating procedures, policies, and processes and how those impact business partners' operations.
6. Assist with maintenance of SOP documentation, process documentation, and reporting controls to meet audit requirements.
7. Develop and maintain relationships across the wider RQO and risk, quality and network solutions (RQNS) functions to facilitate collaboration and effective communication.
8. Work as part of a team to drive innovation and performance improvements which translate into improved customer outcomes and process efficiencies.
9. Conduct error remediation in advance of CMS/HHS deadlines.

Required Qualifications:

• 1+ years of experience in business/finance analysis/healthcare with foundational knowledge of risk adjustment.
• 1+ years of experience in Microsoft Office suite of products (Excel, PowerPoint, Power BI etc.)
• Demonstrated experience operating successfully in the absence of established procedures.
• Proven experience in acting independently with minimal supervision.
• Intermediate experience in Excel (pivot tables, V or H look ups, data validation, creating internal/external reports).
• Intermediate proficiency in SQL (Oracle, PL/SQL, SQL, SQL*Plus) - ability to pull and analyze data, as well as update and alter internal tables.
• Proven solid organizational skills, including the ability to manage multiple tasks, prioritize workloads, and meet deadlines.
• Proven ability to research conflicting and/or inaccurate data and determine root cause.
• Proven ability to assist with operational readiness tasks such as client implementations, setting up ECG connections for data exchange, performing UAT and integration testing.

Preferred Qualifications:

• Risk adjustment experience.
• Visio experience.
• Understanding relevant computer systems and platforms (e.g.: reporting systems; financial systems; company shared drives; Knowledge Library).
• Foundational knowledge of EDI/837 claim experience.
• Demonstrated high levels of drive, determination, and tenacity.
• Demonstrated ability to present information clearly, concisely, and confidently to meet the needs of the audience.
• Demonstrated ability to communicate analysis including trends and opportunities to business partners both written and verbally.
• Demonstrated ability to perform well under pressure, work independently and balance workload to meet customer expectations.
• Demonstrated ability to develop and recommend performance and system improvements through user stories and defects.
• Proactively identify solutions and work with team to solve complex problems.

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). The salary for this role will range from $71,200 to $127,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

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