Senior Director, Payment Integrity Exploratory & Growth Leader, Operations

Requisition Number: 2344317
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.
Payment Integrity Exploratory Operations within Optum Payer Operations is responsible for driving the development and execution of medical cost savings growth for UnitedHealthcare and client health plans by ensuring payment accuracy to support the enterprise objectives. Exploratory Operations drive significant medical costs savings from claims received by health care providers through all lines of business / health plans in parallel to other operations within Payer Payment Integrity, technology, analytic & enablement teams.
This role will drive ideation and growth across the Payment Integrity product suite, working with affordability partners and other enablement teams to progress a clear strategic growth vision and a high level of operational effectiveness. The successful candidate is to provide leadership specifically focused on exploratory, leakage detection and incremental Medical Cost Savings growth outcomes and achieve a positive IOI outcome for the clinical and nonclinical products.
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 Dublin or Letterkenny office and telecommuting from a home-based office in a hybrid work model.
Primary Responsibilities:

• Accountable for developing and driving the Exploratory and Competitive Intelligence strategy, serving as a thought leader and progressing incremental growth opportunities for Payment Integrity suite of products
• Lead the development and deployment of advanced analytical models, including AI/ML, anomaly detection, and predictive risk scoring to identify 'insights', signal and emerging external leakage patterns across medical spend categories
• Integrate enterprise level data science capabilities to design scalable, repeatable insight / lead generation which identify and solution high value ideation opportunities, quantify incremental savings, and accelerate validation cycles
• Partner with Product, Technology, and Operations to architect automation solutions including rules, decisioning logic, and workflow orchestration tools that streamline exploratory processes, reduce manual validation effort, and improve accuracy of payment integrity interventions
• Lead global Exploratory growth processes ensuring effective collaboration and management of performance outcomes (KPIs) to ensure efficient value delivery across all spend categories
• Lead Competitive Intelligence, external leakage, and emerging medical spend trends, developing strategies to address these trends and capitalize on market share for Payment Integrity products
• Foster a culture of innovation, continuous improvement and inclusive work environment which promotes professional growth and development
• Skilled in innovation and communication, able to translate complex concepts into simple language to enhance understanding, initiative approval and streamline processes for optimum value delivery
• Leads an Exploratory team consisting of Ideators, Analysts, Auditors and solution partners, responsible for generating and validating new initiatives to improve payment accuracy and generate Medical Cost Savings

You will 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 providing development for other roles you may be interested in.
Required Qualifications:

• Bachelor's degree in a relevant field or equivalent experience
• Demonstrated in-depth knowledge of the US healthcare industry, including major healthcare entities and the claims lifecycle
• Proven extensive experience in successfully leading operational teams, ideation, and deploying initiatives in the healthcare industry
• Proven extensive experience in monitoring and analyzing shifting industry trends in healthcare delivery and their impact on claims adjudication and payment
• Proven experience in Payment Integrity, with expertise in ensuring accurate and efficient claims adjudication and payment processes
• Proven business leadership experience in a large-scale and highly matrixed organization
• Demonstrated solid conceptual and analytical skills, with the ability to understand complex healthcare systems and identify opportunities for improvement
• Demonstrates exceptional strategic thinking, problem-solving, and analytical skills with a focus on innovation
• Demonstrates excellent leadership, communication, and interpersonal abilities
• Proven ability to thrive in a fast-paced, dynamic environment and manage multiple priorities

Preferred Qualifications:

• Six Sigma certification with a deep understanding of LEAN process methodologies
• Proven experience in business process management, with a focus on implementing end-to-end process improvement strategies
• Demonstrated proficiency at a senior management level, with a proven track record of leading and managing teams through business solution change cycles

Please note you must currently be eligible to work and remain indefinitely without any restrictions in the country to which you are making an application. Proof will be required to support your application.
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: Optum is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to gender, civil status, family status, sexual orientation, disability, religion, age, race, and membership of the Traveller community, or any other characteristic protected by law. Optum is a drug-free workplace. © 2026 Optum Services (Ireland) Limited. All rights reserved.