ZipRecruiter

Log In

1

Optum Claims Editing Jobs in Virginia (NOW HIRING)

All JobsOptum Claims Editing JobsOptum Claims Editing Jobs in Virginia

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 Virginia?

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

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

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

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

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

Optum Claims Editing jobs near you
Infographic showing various Optum Claims Editing job openings in Virginia as of August 2026, with employment types broken down into 83% Full Time, and 17% Contract. Highlights an 68% In-person, 8% Hybrid, and 24% Remote job distribution.

Senior Business System Analyst - Remote

Sentara Healthcare

Richmond, VA • On-site, Remote

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Re-posted 16 days ago

Sentara Health rating

6.7

Company rating: 6.7 out of 10

Based on 412 frontline employees who took The Breakroom Quiz

532nd of 891 rated healthcare providers

Job description

City/State
Richmond, VA
Work Shift
Multiple shifts available
Overview:
Sentara Health Plans is looking to hire a Senior Business System Analyst!
This is a fully remote position.
Remote opportunities available in the following states: Virginia, North Carolina, Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Washington (state), West Virginia, Wisconsin, Wyoming .
Description
This position is responsible for support, enhancement and implementation software applications used within the organization. Oversee and directs intermediate scale projects or components of large-scale projects; develops project plans and timelines and coordination of project resources.
Incumbent will identify opportunities to leverage technologies in areas that improve and enhance business practices by designing and implementing application/product enhancements. Works with and is a liaison to customers and end-users, appropriate IT personnel and software vendors on a regular basis to align technological functionality to operational processes. Assess, research, analyze, and document stakeholder needs, selecting the appropriate information gathering and/or modeling technique to elicit requirements. Develop detailed test cases, execute them, and share results with business and tech managers for approval. Work jointly with developers to solution and provide cost and time estimates on fixes and enhancements. Performs longer term analysis and design of systems and hardware to maintain the production environments. Synthesize requirements and develop recommendations that best meet the objectives of the business. Works on project teams that are developing or modifying very complex information systems.
Education
  • Bachelor's degree preferably in a field such as Computer Science, Business, Technical, Education, Information Systems, Finance, Business Administration, Accounting, Engineering, Information Technology (Required)

Or
  • Candidates without a bachelor's degree with 6 or more years of relevant experience may be considered.

Experience:
  • 4 years of relevant experience (Required)
  • Proficiency in SQL, HTML, and CSS (Preferred)
  • Experience with pricing configuration in NetworX Pricer (Preferred)
  • Experience in claims editing (Required).
  • NetworX Payment Bundling Administration (PBA), Optum Claims Edit System (CES) or Zelis. (Preferred)
  • Experience with pricing configuration for Commercial plans (Required)
  • Experience with QNXT preferred but will accept experience with Facets

We provide market-competitive compensation packages, inclusive of base pay, incentives, and benefits. The base pay rate for Full Time employment is: 69,867- 116,438. Additional compensation may be available for this role such as shift differentials, standby/on-call, overtime, premiums, extra shift incentives, or bonus opportunities
Talroo-IT, pricing configuration, NetworX Pricer, pricing, NetworX Payment Bundling Administration (PBA), Optum Claims Edit System (CES), Zelis, fee schedule, pricing analyst, QNXT, Facets, SQL, Medicare, Medicaid, commercial, provider agreement, provider contract, configuration analyst, configuration, pricing configuration, NetworX, Pricer, NetworX Pricer, contract implementation, business analyst, commercial health plan, health plan
Benefits: Caring For Your Family and Your Career
• Medical, Dental, Vision plans
• Adoption, Fertility and Surrogacy Reimbursement up to 10,000
• Paid Time Off and Sick Leave
• Paid Parental & Family Caregiver Leave
• Emergency Backup Care
• Long-Term, Short-Term Disability, and Critical Illness plans
• Life Insurance
• 401k/403B with Employer Match
• Tuition Assistance - 5,250/year and discounted educational opportunities through Guild Education
• Student Debt Pay Down - 10,000
• Reimbursement for certifications and free access to complete CEUs and professional development
• Pet Insurance
• Legal Resources Plan
• Colleagues have the opportunity to earn an annual discretionary bonus if established system and employee eligibility criteria is met.
Sentara Health is an equal opportunity employer and prides itself on the diversity and inclusiveness of its close to an almost 30,000-member workforce. Diversity, inclusion, and belonging is a guiding principle of the organization to ensure its workforce reflects the communities it serves.
In support of our mission "to improve health every day," this is a tobacco-free environment.
For positions that are available as remote work, Sentara Health employs associates in the following states:
Alabama, Delaware, Florida, Georgia, Idaho, Indiana, Kansas, Louisiana, Maine, Maryland, Minnesota, Nebraska, Nevada, New Hampshire, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, South Carolina, South Dakota, Tennessee, Texas, Utah, Virginia, Washington, West Virginia, Wisconsin, and Wyoming.

What Sentara Health employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply