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Optum Claims Editing Jobs in Michigan (NOW HIRING)

Stefanini Group

Business Systems Analyst

Grand Rapids, MI · On-site

$65 - $70/hr

We are seeking a seasoned Business Analyst with expertise in Optum Claims Editing System (CES) with integration experience with Facets and Epic Tapestry. This individual will be responsible for ...

Stefanini

Business Systems Analyst

Grand Rapids, MI · On-site

We are seeking a seasoned Business Analyst with expertise in Optum Claims Editing System (CES) with integration experience with Facets and Epic Tapestry. This individual will be responsible for ...

All JobsOptum Claims Editing JobsOptum Claims Editing Jobs in Michigan

Optum Claims Editing information

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?

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.
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Optum Claims Editing jobs near you
Infographic showing various Optum Claims Editing job openings in Michigan as of August 2026, with employment types broken down into 76% Full Time, and 24% Contract. Highlights an 58% In-person, 13% Hybrid, and 29% Remote job distribution.

Code Editor Business System Analyst

Sunrise Systems, Inc.

Grand Rapids, MI • On-site

Other

Posted 14 days ago

Job description

Job Title: Code Editor Business System Analyst Job ID: 26-03550 Location: Grand Rapids ,MI Duration: 04 months OF W contract
Must Have

  • Optum CES and Facets

Nice To Have

  • Epic Tapestry

Specific Skillset Requirements:
We are seeking a seasoned Business Analyst with expertise in Optum Claims Editing System (CES) with integration experience with Facets and Epic Tapestry. This individual will be responsible for driving CES configuration, edit implementation, and system alignments. The role demands cross-functional collaboration, system analysis, and execution oversight to enhance claims adjudication workflows and ensure alignment with payer strategies, Optum CES and Facets experience.
Expenses allowed: TBD
Job Summary:
Under minimal supervision, formulates and defines systems scope and objectives through research and fact-finding, combined with an understanding of applicable business systems and industry requirements. With this knowledge, develops or modifies moderately-sized information systems. Includes analysis of business and user needs, documenting requirements, and revising existing system logic issues as necessary. Considers the business implications of the application of technology to the current business environment. Assists and advises less-experienced Business Systems Analysts. Competent to work in some phases of systems analysis, but may require guidance in others.
Essential Functions:

  • Under minimal supervision, with the implications of the application of new/differing technology to the current business environment in mind, utilizes research and analysis, along with an understanding of relevant business systems and industry requirements, to define systems scopes and objectives for developing new, or improving existing, information systems.
  • Performs business analysis, workflow analysis and optimization, works with users to define their needs and then document requirements.
  • Collaborates with others to troubleshoot issues with existing systems.
  • Remains current with business requirements and needs, based upon future industry trends and changes and understands the implications for existing technology.

Qualifications:

  • Required Associate's Degree Technical school or equivalent
  • Preferred Bachelor's Degree or equivalent
  • 2 years of relevant experience in the field Required
  • 3 years of relevant experience in the field Preferred
  • Experience formulating and defining systems scopes and objectives Preferred
  • Experience in systems development lifecycle, including requirements gathering and design Preferred
  • Participant in multiple phases of an integrated system implementation Preferred
  • Background in a health care, sciences or information systems Preferred

Physical Demands:

  • Pallet to Waist (6 " from floor) > 5 lbs: Seldom up to 10 lbs
  • Waist to Waist > 5 lbs: Seldom up to 10 lbs
  • Waist to Chest (below shoulder) > 5 lbs: Seldom up to 10 lbs
  • Waist to Overhead > 5 lbs: Seldom up to 5 lbs
  • Bilateral Carry > 5 lbs: Seldom up to 10 lbs
  • Unilateral Carry > 5 lbs: Seldom up to 5 lbs
  • Pushing Force > 5 lbs: Seldom up to 20 lbs
  • Pulling Force > 5 lbs: Seldom up to 15 lbs
  • Sitting: Frequently
  • Standing: Occasionally
  • Walking: Occasionally
  • Forward Bend - Standing: Seldom
  • Forward Bend - Sitting: Seldom
  • Trunk Rotation - Standing: Seldom
  • Trunk Rotation - Sitting: Seldom
  • Squat: Seldom
  • Supine Lying: Seldom
  • Stair Climbing: Seldom
  • Crawling / Kneeling: Seldom
  • Driving: Seldom
  • Reach - Above Shoulder: Seldom
  • Reach - at Shoulder or Below: Seldom
  • Handling: Occasionally
  • Forceful Grip > 5 lbs: Seldom
  • Forceful Pinch > 2 lbs: Seldom
  • Finger/Hand Dexterity: Frequently
  • Visual Acuity 1

[None = No; Seldom = Yes]: Seldom

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