The Role
Designs, develops, and deploys AI/ML and generative AI solutions for healthcare claims, including fraud detection, overpayment disputes, workflow automation, and document understanding. Builds LLM applications, RAG frameworks, and prompt engineering solutions; develops evaluation and validation processes; optimizes model deployment and inference; and supports responsible AI governance. Collaborates with engineering, product, analytics, data science, and business teams to deliver scalable solutions and measurable operational improvements.
Summary Generated by Built In
Requisition Number: 2380112
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:
Required Qualifications:
Preferred Qualifications:
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.
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:
- Design, develop, and implement AI/ML and Generative AI solutions supporting Core Claims initiatives including Duplicate Overpayments, Fraud, Waste & Abuse (FWA) Disputes, and First Pass Claims
- Develop and deploy Large Language Model (LLM) powered applications, prompt engineering solutions, and Retrieval-Augmented Generation (RAG) frameworks
- Apply AI techniques to automate claims workflows including classification, intelligent routing, document understanding, decision support, and operational triage
- Collaborate with engineering, product, analytics, and business teams to build scalable AI solutions that address complex business challenges
- Develop frameworks for model evaluation, performance testing, validation, and continuous improvement
- Partner with data science and engineering teams on feature engineering, model deployment, inference optimization, and production support
- Ensure adherence to Responsible AI practices, including explainability, governance, fairness, and model validation standards
- Identify opportunities to improve operational efficiency through AI-driven automation and intelligent decision-making
- Stay current with advancements in Artificial Intelligence, Generative AI, Large Language Models, and related technologies
- 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 regards 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:
- Bachelor's or Master's degree in Computer Science, Artificial Intelligence, Machine Learning, Data Science, or a related field
- 7+ years of experience in AI/ML solution development, with hands-on experience in Generative AI and Large Language Models (LLMs)
- Experience building and deploying LLM-powered applications, RAG architectures, prompt engineering solutions, and intelligent automation systems
- Experience with model evaluation frameworks, performance optimization, and AI solution validation
- Experience collaborating with cross-functional teams across engineering, analytics, product management, and business functions
- Understanding of Responsible AI principles, model explainability, governance, and ethical AI practices
- Solid proficiency in Python and modern AI/ML frameworks and toolchains
- Proven problem-solving, communication, stakeholder management, and presentation skills
Preferred Qualifications:
- Experience within healthcare, healthcare claims, payment integrity, fraud detection, or operational analytics domains
- Experience with cloud-based AI/ML platforms and MLOps practices
- Experience delivering AI solutions that drive measurable business outcomes and operational efficiencies
- Knowledge of Medicare & Retirement (M&R) Claims processes and operations
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.
Skills Required
- Bachelor's or Master's degree in Computer Science, Artificial Intelligence, Machine Learning, Data Science, or a related field
- 7+ years of experience in AI/ML solution development
- Hands-on experience with Generative AI and Large Language Models
- Experience building and deploying LLM-powered applications, RAG architectures, prompt engineering solutions, and intelligent automation systems
- Experience with model evaluation frameworks, performance optimization, and AI solution validation
- Experience collaborating across engineering, analytics, product management, and business functions
- Understanding of Responsible AI principles, model explainability, governance, and ethical AI practices
- Solid proficiency in Python and modern AI/ML frameworks and toolchains
- Problem-solving, communication, stakeholder management, and presentation skills
- Experience in healthcare, healthcare claims, payment integrity, fraud detection, or operational analytics
- Experience with cloud-based AI/ML platforms and MLOps practices
- Experience delivering AI solutions that drive measurable business outcomes and operational efficiencies
- Knowledge of Medicare and Retirement Claims processes and operations
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The Company
What We Do
Optum, part of the UnitedHealth Group family of businesses, 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. At Optum, we support your well-being with an understanding team, extensive benefits and rewarding opportunities. By joining us, you’ll have the resources to drive system transformation while we help you take care of your future. We recognize the power of connection to drive change, improve efficiency and make a difference in health care. Join a team where your skills and ideas can make an impact and where collaboration is key to creating technology that produces healthier outcomes.
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Optum Offices
Hybrid Workspace
Employees engage in a combination of remote and on-site work.
Optum has three workplace models that balance the needs of the business and the responsibilities of each role. These models, core on‑site (5 days/week), hybrid (4 days/week) and telecommute or fully remote, vary by country, role and location.
Typical time on-site:
Not Specified
