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Optum Claims Editing Jobs in Minnesota (NOW HIRING)

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Optum Claims Editing information

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.

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 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 popular job titles related to Optum Claims Editing jobs in Minnesota?

For Optum Claims Editing jobs in Minnesota, the most frequently searched job titles are:

What job categories do people searching Optum Claims Editing jobs in Minnesota look for?

The top searched job categories for Optum Claims Editing jobs in Minnesota are:

What cities in Minnesota are hiring for Optum Claims Editing jobs?

Cities in Minnesota with the most Optum Claims Editing job openings:

Optum Claims Editing jobs near you
Infographic showing various Optum Claims Editing job openings in Minnesota as of August 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution.

Senior Medical Coding Analyst

Saint Paul, MN • On-site

Blue Cross Blue Shield of Minnesota
Insurance Services • 1 - 5K employees

7.1

Company rating: 7.1 out of 10

Based on 9 frontline employees who took The Breakroom Quiz

252nd of 314 rated insurance

Good employer

Respectful managers

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Learn more about Blue Cross Blue Shield of Minnesotaexternal

$90K - $120K/yr

Other

Medical, Dental, Vision, Life, Retirement, PTO

Posted 12 days ago

Job description

Senior Business Analyst - Medical Coding Configuration

We are seeking an experienced Senior Business Analyst - Medical Coding Configuration to support Medicaid claims processing and payment integrity initiatives. This role focuses on analyzing, configuring, and maintaining medical coding and claims editing rules that drive claim adjudication outcomes, including payment, denial, and pended claim scenarios. The ideal candidate will have deep expertise in healthcare claims processing, medical coding methodologies, and claims editing configuration, with hands-on experience in Optum CES (Claims Editing System) and/or FACETS.

Conducts in-depth research and analysis.

Identifies trends, emerging issues and recommends best practices to ensure maximum results and develops metrics.

Documents metrics and process changes.

Effectively analyzes, designs, develops, tests, debugs, implements, maintains and/or enhances new or existing systems through reporting and documentation.

Participate in and coordinate individual projects and related activities to ensure project progresses on schedule.

Maintains adequate communication regarding project status, risks, issues, and priorities with project sponsors and leadership.

Acts as a liaison with internal partners and external partners to identify opportunities and needs and researches/develops implementation plans for meeting these needs.

Responsible for representing the customer and/or stakeholder (internal/external) while collaborating with business and technical units.

Serves as senior subject matter expert associated with content, processes, and procedures.

May lead project teams and may provide training to lower level staff to achieve project milestones and objectives.

Performs additional responsibilities consistent with the scope and level of the role, as assigned.

5+ years of related information technology professional experience.

Bachelor's degree; in lieu of a degree, an additional two years of relevant experience beyond the qualifications listed above may be accepted.

Hybrid

$90,800.00 - $120,300.00 - $149,800.00 Annual

Pay is based on several factors which vary based on position, including skills, ability, and knowledge the selected individual is bringing to the specific job.

We offer a comprehensive benefits package which may include:

  • Medical, dental, and vision insurance
  • Life insurance
  • 401k
  • Paid Time Off (PTO)
  • Volunteer Paid Time Off (VPTO)
  • And more

To discover more about what we have to offer, please review our benefits page.

At Blue Cross and Blue Shield of Minnesota, we are committed to paving the way for everyone to achieve their healthiest life. Blue Cross of Minnesota is an Equal Opportunity Employer and maintains an Affirmative Action plan, as required by Minnesota law applicable to state contractors. All qualified applications will receive consideration for employment without regard to, and will not be discriminated against based on any legally protected characteristic.

Individuals with a disability who need a reasonable accommodation in order to apply, please contact us at: talent.acquisition@bluecrossmn.com.

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