Senior Claims Data Analyst - Telecommute at Optum

| Hampton Roads, VA +25 more | Remote
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Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)
Do you crave a challenge and relish the opportunity to solve complex problems using revolutionary thinking? If so, then take the next step in your career and dive deep into the world of data analysis and analytic development. Help us transform the health care industry by joining a dynamic team of analysts dedicated to developing innovative analytics and automations that drive health care cost savings.
You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
  • Research potential overpayment scenarios through the use of client policies and provider contracts, seeking to identify overpaid claims used to build recurring algorithms
  • Identify and refine criteria to successfully build and enhance new and existing algorithm logic, ensuring correct claim payment
  • Research and quickly identify patterns of claim payment abnormalities through big data analysis
  • Develop metrics to forecast new algorithm profitability
  • Write business requirements documentation for new algorithms and update existing documents as the algorithm logic is developed or changes over time
  • Maintenance existing production algorithms to maximize performance while working directly with programmers to test and implement changes
  • Facilitate new algorithm kickoff calls and training with matrix partners
  • Monthly analysis of algorithm performance; forecasted vs. actuals
  • Lead special projects with little to no manager supervision or assistance
  • Breakdown complex problems into individual root cause

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:
  • 3+ years of experience working healthcare claims lifecycle (ie: submission, processing, adjudication, and payment)
  • 2+ years of experience and in-depth knowledge of claims processing or claims auditing within CSP, COSMOS
  • Experience detecting data anomalies through the use of large data sets
  • Experience communicating thru multiple mediums to a variety of stakeholders
  • Experience working in a high-paced environment
  • Proficient with Excel (must be able to create pivot tables, add foundational formulas, charts, etc.)
  • Ability to effectively engage with internal clients (employees and leaders within other areas of the business)
  • Telecommute is available for this opportunity

Preferred Qualification:
  • Analytical mindset with critical thinking skills

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $66,100 to $118,300. The salary range for Connecticut / Nevada residents is $72,800 to $129,900. 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.
*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
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 bylower 48 law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job Keywords: Senior Claims Data Analyst, claims, claims system, CSP, COSMOS, over payment, retrospective, prospective, telecommuter, remote, work from home, telecommute
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Candidate Location Eligibility:
Ann Arbor, MI
Atlanta, GA
Austin, TX
Baltimore, MD
Boston, MA
Chicago, IL
Dallas-Fort Worth, TX
Detroit, MI
Hartford, CT
Houston, TX
Jacksonville, FL
Las Vegas, NV
Los Angeles, CA
Louisville, KY
Madison, WI
Minneapolis–Saint Paul, MN
Nashville, TN
New York City, NY
Philadelphia, PA
Phoenix – Mesa – Scottsdale, AZ
Raleigh-Durham, NC
San Diego, CA
San Francisco, CA
Seattle, WA
Washington DC

Technology we use

  • Engineering
  • Product
    • .NETLanguages
    • JavaLanguages
    • JavascriptLanguages
    • PythonLanguages
    • ScalaLanguages
    • SqlLanguages
    • JenkinsLanguages
    • AngularJSFrameworks
    • HadoopFrameworks
    • SparkFrameworks
    • SpringFrameworks
    • AWS (Amazon Web Services)Frameworks
    • KafkaFrameworks
    • LinuxFrameworks
    • KubernetesFrameworks
    • DockerFrameworks
    • SnowflakeDatabases
    • Google AnalyticsAnalytics
    • SmartsheetManagement

What are Optum Perks + Benefits

Health Insurance & Wellness Benefits
Flexible Spending Account (FSA)
Disability Insurance
Dental Benefits
Vision Benefits
Health Insurance Benefits
Life Insurance
Pet Insurance
Wellness Programs
Onsite Gym
Team workouts
Mental Health Benefits
Retirement & Stock Options Benefits
401(K)
401(K) Matching
Employee Stock Purchase Plan
Performance Bonus
Child Care & Parental Leave Benefits
Child Care Benefits
Generous Parental Leave
Adoption Assistance
Vacation & Time Off Benefits
Generous PTO
Paid Holidays
Professional Development Benefits
Tuition Reimbursement

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