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How much do optum claims editing jobs pay per hour?

As of Jun 11, 2026, the average hourly pay for optum claims editing in the United States is $21.05, according to ZipRecruiter salary data. Most workers in this role earn between $18.03 and $22.84 per hour, depending on experience, location, and employer.

What is the difference between Optum Claims Editing vs Medical Billing Specialist?

AspectOptum Claims EditingMedical Billing Specialist
CredentialsCertification in claims processing or related fields often preferredCertification in medical billing or coding often preferred
Work EnvironmentHealthcare insurance companies, third-party administratorsMedical offices, hospitals, billing companies
Employer & IndustryInsurance providers, healthcare payersHealthcare providers, billing services
Primary FocusReviewing and editing insurance claims for accuracyPreparing and submitting medical bills to insurers

Optum Claims Editing specialists focus on reviewing and correcting insurance claims to ensure proper reimbursement, often working within insurance companies or third-party administrators. Medical Billing Specialists handle the entire billing process, including preparing and submitting claims to insurers. While both roles require knowledge of healthcare billing and insurance processes, Optum Claims Editing emphasizes claim accuracy and compliance, whereas Medical Billing Specialists focus on the end-to-end billing cycle.

What are the key skills and qualifications needed to thrive as an Optum Claims Editing Specialist, and why are they important?

To thrive as an Optum Claims Editing Specialist, you need a solid understanding of medical billing, coding (such as ICD-10, CPT, and HCPCS), and health insurance processes, often supported by a degree in healthcare administration or a coding certification. Familiarity with claims editing systems like Optum CES, payer portals, and healthcare management software is essential. Attention to detail, analytical thinking, and strong communication skills help ensure accurate claim review and collaboration with providers. These skills are critical for minimizing claim denials, ensuring compliance, and optimizing healthcare reimbursements.

What are some common challenges faced in an Optum Claims Editing role, and how can I effectively address them?

In an Optum Claims Editing role, you may frequently encounter complex claim discrepancies, policy updates, and high volumes of claims requiring timely review. Staying current with insurance regulations and payer guidelines is key to minimizing errors and rework. Collaborating closely with team members, leveraging internal resources, and participating in ongoing training can help you stay effective and maintain accuracy. Proactively communicating with supervisors and cross-functional teams also ensures smoother resolution of challenging claims.

What is Optum Claims Editing?

Optum Claims Editing refers to the process and technology used by Optum, a health services company, to review and validate healthcare claims before they are submitted for payment. This process helps ensure claims are accurate, comply with payer rules and regulations, and identify potential errors or fraud. The claims editing system applies automated rules to check information such as coding accuracy, eligibility, and medical necessity. By catching issues early, Optum helps healthcare providers reduce claim denials and speed up reimbursement. Many organizations use Optum's solutions to streamline their revenue cycle and improve overall claims management.
More about Optum Claims Editing jobs
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Optum Claims Editing jobs near you
Business Analyst, Optum CES

Business Analyst, Optum CES

Co-Sourcing Partners

Chicago, IL • On-site

Contractor

Posted 20 days ago

Job description

Business Analyst, Optum CES
Location: Remote
Employment Type: 1 month contract with possibility of extension
We are seeking a seasoned Business Analyst with deep expertise in Optum Claims Editing System (CES) and integration experience with Epic Tapestry. This individual will be responsible for driving CES configuration, edit implementation, and system alignment with Epic denial codes and benefit configurations. The role demands cross-functional collaboration, system analysis, and execution oversight to enhance claims adjudication workflows and ensure alignment with payer strategies.
Key Responsibilities:
  • Collaborate with stakeholders including business leaders, claims operations, IT teams, and vendors to guide the end-to-end implementation of Optum CES.
  • Analyze and document business requirements related to claims editing rules, benefit configuration, and adjudication logic.
  • Design and validate system edits (e.g., age edits, duplicate logic, modifier rules) to ensure compliance with regulatory and payer-specific policies.
  • Map and reconcile EDI transactions (837/835) with Epic Tapestry records to ensure accurate CES integration.
  • Partner with configuration analysts to ensure benefit structures and payment policies align with claims editing logic.
  • Lead and support functional testing, UAT, and defect resolution for CES edits and Epic denial workflows.
  • Monitor project timelines, milestones, risks, and cross-functional dependencies to ensure on-time delivery.
  • Identify and recommend process improvements to reduce manual intervention and enhance claims accuracy and provider experience.

Required Skills & Experience:
  • Minimum 5 years of experience as a Business Analyst in healthcare IT, with hands-on implementation of Optum CES.
  • Stong understanding of PPS reimbursement within the claims processing cycle.
  • Experience with Epic Tapestry strongly preferred.
  • Proficiency in claims editing systems, claims adjudication logic, and healthcare EDI standards (837/835).
  • Demonstrated ability to lead cross-functional initiatives involving technical and business teams.
  • Strong written and verbal communication skills, with the ability to translate complex technical details into business-friendly language.
  • Exceptional organizational skills and a track record of managing high-impact healthcare IT projects.

CoSourcing Partners is an equal opportunity employer committed to fostering an inclusive and diverse workplace. We do not discriminate based on race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, genetic information, or any other protected status under applicable federal, state, or local laws.
We believe in creating a work environment where all employees feel valued, respected, and empowered to contribute to our success. Accommodations are available upon request for applicants with disabilities throughout the hiring process.
Join us and be part of a team that values diversity, equity, and inclusion.

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