Ncqa Validation Analyst Jobs (NOW HIRING)

Optum Tech is a global leader in health care innovation. Our teams develop cutting-edge solutions that help people live healthier lives and help make the health system work better for everyone. From advanced data analytics and AI to cybersecurity, we use innovative approaches to solve some of health care's most complex challenges. Your contributions here have the potential to change lives. Ready to build the next breakthrough? Join us to start Caring. Connecting. Growing together.

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:

• Define and drive the data architecture for Optum Health's Risk Adjustment and Quality platform
• Architect scalable, secure, and governed solutions that integrate claims, encounters, eligibility, provider, member, EHR, lab, pharmacy, and other clinical data into a unified data platform
• Design canonical, logical, and physical data models for core healthcare domains such as member/patient, provider, coverage, diagnosis, condition, encounter, procedure, medication, lab result, risk score, quality measure, and gap status
• Lead architecture for data products and pipelines that support:
  • Risk Adjustment Framework
  • Prospective and retrospective risk adjustment workflows
  • Coding capture and suspecting
  • HEDIS / Stars / NCQA reporting and gap closure
  • Quality performance analytics and operational workflows
  • Establish architecture patterns for ingesting and normalizing data from:
  • X12 transactions (e.g., 837, 835, 834, 270/271)
  • HL7 v2/v3 and CCD/C-CDA
  • FHIR APIs and bulk interoperability feeds
  • EHR, practice management, payer, and external partner systems
• Partner with business and domain leaders to ensure architecture supports the nuances of Medicare Advantage, quality programs, evolving CMS and NCQA requirements, and downstream operational use cases
• Ensure full alignment with HIPAA, PHI, privacy, security, access control, auditability, and data retention requirements
• Define and implement standards for data quality, lineage, metadata, semantic consistency, reconciliation, and traceability from source systems through measure/risk outputs
• Drive architecture decisions for identity resolution, provider and member mastering, source-of-truth alignment, and data harmonization across payer and provider ecosystems
• Collaborate with data engineering and platform teams on cloud-native architecture patterns including warehouse design, API-led integration, event-driven patterns, and high-volume batch/near-real-time processing
• Support audit-readiness for risk and quality programs, including traceability needed for RADV, NCQA validation/audits, and internal control frameworks
• Lead architecture reviews, create reusable standards and design patterns, and mentor senior engineers and architects across the organization
• Communicate complex technical concepts clearly to executive, operational, and clinical stakeholders

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:

• Undergraduate degree in applicable area of expertise or equivalent experience
• 5 years of experience in healthcare data architecture, data engineering, enterprise data, or information architecture, with increasing scope and seniority
• Demonstrated experience supporting HEDIS, Stars, and NCQA quality data needs, including quality measure data sourcing, attribution, gap identification, and reporting architecture
• Demonstrated expertise with healthcare interoperability standards including: FHIR, HL7, X12
• Demonstrated solid data modeling skills, including canonical models, dimensional models, and data product/domain-oriented design

Preferred Qualifications:

• Master's degree in a relevant technical or healthcare field
• 2 years in a lead or principal architecture role designing enterprise-scale healthcare data solutions
• Experience designing solutions on modern cloud data platforms and enterprise data ecosystems
• Experience establishing or enforcing data governance disciplines such as lineage, metadata, data quality controls, stewardship, and source-to-target traceability
• Experience in Medicare Advantage and other value-based care environments
• Experience with RAPS/EDPS, chart review data, coding operations, or provider documentation improvement workflows
• Experience supporting digital quality initiatives, eCQMs, CQL, or FHIR-based quality measurement
• Experience with provider clinical systems such as Epic, Cerner/Oracle Health, or other enterprise EHR platforms
• Experience with modern cloud technologies and tools such as Snowflake, Databricks, Azure, GCP, dbt, Kafka, or comparable platforms
• Experience with master data management, enterprise MPI/EMPI, or identity resolution frameworks
• Experience working in highly regulated, large-scale healthcare enterprises with complex partner ecosystems
• Solid knowledge of HIPAA/PHI requirements and secure data design principles including minimum necessary access, role-based controls, encryption, audit logging, and de-identification where appropriate
• Working familiarity with CCD/C-CDA and broader clinical exchange patterns
• Demonstrated expertise in healthcare data architecture across payer, provider, or integrated care settings
• Demonstrated domain expertise in CMS-HCC / RAF, including the data structures, workflows, and controls required to support risk adjustment use cases
• Exposure to AI/ML-enabled use cases such as risk suspecting, gap prioritization, or clinical NLP

*All employees working remotely 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 $134,600 to $230,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

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.