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Optum Payment Integrity Jobs (NOW HIRING)

UnitedHealth Group

Financial Consultant

Eden Prairie, MN · On-site

$72K - $130K/yr

This role will support the Optum Insight Expense Analytics ownership of real-time forecasting of Non-Workforce expenses across the Payment Integrity, Risk Adjustment, and Admin sub-markets, with a ...

UnitedHealth Group

Financial Consultant

Eden Prairie, MN · On-site

$72K - $130K/yr

This role will support the Optum Insight Expense Analytics ownership of real-time forecasting of Non-Workforce expenses across the Payment Integrity, Risk Adjustment, and Admin sub-markets, with a ...

Optum

Financial Counselor, Patient Access

Mukwonago, WI

$17.74 - $31.63/hr

$2,000 SIGN ON BONUS FOR EXTERNAL APPLICANTS Explore opportunities with Optum , in strategic ... payment sources, developing payment plans, and collecting patient payments. Our office is located ...

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Optum Payment Integrity information

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How much do optum payment integrity jobs pay per hour?

As of Jun 15, 2026, the average hourly pay for optum payment integrity in the United States is $17.99, according to ZipRecruiter salary data. Most workers in this role earn between $15.38 and $19.71 per hour, depending on experience, location, and employer.

What is Optum Payment Integrity?

Optum Payment Integrity refers to a set of services and solutions provided by Optum, a health services and innovation company, aimed at ensuring that healthcare claims are paid accurately and appropriately. This involves detecting and preventing improper payments, identifying fraud, waste, and abuse, and ensuring compliance with healthcare regulations. Professionals working in Optum Payment Integrity analyze claims data, implement safeguards, and work with healthcare providers and payers to resolve billing issues and recover overpayments. The goal is to improve financial outcomes for healthcare organizations while maintaining quality patient care.

What is the difference between Optum Payment Integrity vs Optum Claims Analyst?

AspectOptum Payment IntegrityOptum Claims Analyst
CertificationsRelevant healthcare and insurance certifications, such as CPC or CCSLikely similar certifications, often including CPC or equivalent
Work EnvironmentHealthcare insurance companies, focusing on fraud detection and payment accuracyHealthcare insurance companies, focusing on claims processing and analysis
Employer & Industry UsageUsed in healthcare insurance to prevent fraud and ensure payment accuracyUsed in healthcare insurance to process and analyze claims data

Optum Payment Integrity and Optum Claims Analyst roles both operate within healthcare insurance companies, sharing similar certifications and work environments. However, Payment Integrity focuses on fraud detection and payment accuracy, while Claims Analysts handle claims processing and analysis. Both roles are essential for maintaining efficient healthcare payment systems.

What are the key skills and qualifications needed to thrive in Optum Payment Integrity, and why are they important?

To thrive in Optum Payment Integrity, you need analytical skills, attention to detail, and a background in healthcare administration, finance, or related fields. Familiarity with claims management systems, healthcare coding (such as ICD-10, CPT), and data analysis tools is typically required. Strong problem-solving abilities, effective communication, and teamwork are essential soft skills in this role. These skills ensure accurate claims review, fraud prevention, and effective collaboration, ultimately supporting financial health and compliance within the healthcare system.

What are some common challenges faced by professionals in Optum Payment Integrity roles, and how can they be addressed?

Professionals in Optum Payment Integrity often encounter challenges such as interpreting complex healthcare claims, keeping up with regulatory changes, and balancing accuracy with efficiency. These roles require careful attention to detail and strong analytical skills, as well as the ability to collaborate closely with both clinical and data analytics teams. Staying current with training on evolving healthcare policies and leveraging internal resources can help address these challenges, ensuring accurate payment and minimizing errors or fraud.
More about Optum Payment Integrity jobs
What job categories do people searching Optum Payment Integrity jobs look for? The top searched job categories for Optum Payment Integrity jobs are:
Infographic showing various Optum Payment Integrity job openings in the United States as of June 2026, with employment types broken down into 100% Full Time. Highlights an 17% In-person, and 83% Remote job distribution, with an average salary of $37,422 per year, or $18 per hour.
Medical Economics Analyst-Payment Integrity

Medical Economics Analyst-Payment Integrity

Presbyterian Healthcare Services

Santa Fe, NM • On-site, Remote

$83K - $127K/yr

Full-time

Medical, Dental, Vision, Life

Posted 21 days ago

Presbyterian Healthcare Services rating

7.3

Company rating: 7.3 out of 10

Based on 158 frontline employees who took The Breakroom Quiz

251st of 872 rated healthcare providers

Job description

Location Address:
Remote OfficeSanta Fe, NM 87501
Compensation Pay Range:
Minimum Offer $83,366.40Maximum Offer $127,275.20Now Hiring: Medical Economics Analyst-Payment Integrity
Summary:
Build your Career. Make a Difference. Presbyterian is hiring a skilled Medical Economics Analyst-Payment Integrity to join our team.Type of Opportunity: Full timeJob Exempt: YesJob is based: Remote Workers New MexicoWork Shift: Weekday Schedule Monday-Friday (United States of America)
Responsibilities:
The Payment Integrity Medical Economics Analyst plays a critical role in identifying, quantifying, and validating medical cost savings opportunities through deep partnership with the Payment Integrity team. This role combines advanced analytics, claims validation, and financial insight to ensure accuracy of payments, integrity of savings initiatives, and alignment to total cost of care (TCOC) objectives.
This individual will leverage enterprise data assets, including claims and provider data, to produce actionable insights, validate recoveries, and support pre- and post-pay integrity initiatives. The role requires strong technical expertise (SQL/SAS), comfort working with large healthcare datasets, and the ability to translate findings into clear financial impact.
Some key responsibilities include:
  • Partner closely with Payment Integrity, Operations, and vendor partners (e.g., Cotiviti, Optum) to support pre-pay and post-pay initiatives
  • Analyze claims data to identify patterns of overpayment, billing anomalies, and coding discrepancies
  • Support development and refinement of rules, algorithms, and audit strategies to improve payment accuracy
  • Translate operational PI activities into measurable financial outcomes tied to TCOC
  • Validate identified savings opportunities through detailed claims-level analysis and audit review
  • Develop and maintain methodologies to quantify gross and net savings (pre-pay edits, post-pay recoveries, avoidance)
  • Perform before/after and control group analyses to ensure credibility of savings estimates
  • Partner with finance to align validated savings with general ledger and financial reporting
  • Extract, transform, and analyze large-scale healthcare datasets using SQL, SAS, or similar tools
  • Work within enterprise data warehouse environments to build repeatable datasets and analytic pipelines
  • Develop dashboards and reporting tools to monitor payment integrity performance and trends
  • Support integration of external/vendor outputs into internal analytics frameworks
  • Produce clear, concise reporting on payment integrity performance, savings, and emerging opportunities
  • Develop executive-ready summaries highlighting key drivers, risks, and recommended actions
  • Support ongoing monitoring of initiative performance and identification of new opportunities
  • Generate pre-payment edit contribution invoices for Self-Funded accounts

Qualifications:
  • Bachelor's degree in Actuarial Science, Economics, Finance, Data Analytics, Healthcare Administration, or related field (or equivalent experience)
  • 2-5+ years of experience in healthcare analytics, medical economics, or payment integrity
  • Strong technical skills in SQL and/or SAS (required); experience querying large relational databases
  • Experience working with claims data and reimbursement methodologies (fee schedules, IPPS, OPPS)
  • Demonstrated ability to perform financial and statistical analysis on large datasets
  • Strong problem-solving skills with attention to detail and data accuracy

All benefits-eligible Presbyterian employees receive a comprehensive benefits package that includes medical, dental, vision, short-term and long-term disability, group term life insurance and other optional voluntary benefits.
Wellness
Presbyterian's Employee Wellness rewards program is designed to provide you with engaging opportunities to enhance your health and activate your well-being. Earn gift cards and more by taking an active role in our personal well-being by participating in wellness activities like wellness challenges, webinar, preventive screening and more.
Why work at Presbyterian?
As an organization, we are committed to improving the health of our communities. From hosting growers' markets to partnering with local communities, Presbyterian is taking active steps to improve the health of New Mexicans.
About Presbyterian Healthcare Services
Presbyterian exists to improve the health of patients, members, and the communities we serve. We are locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1600 providers and nearly 4,700 nurses.
Our health plan serves more than 580,000 members statewide and offers Medicare Advantage, Medicaid (Centennial Care) and Commercial health plans.
AA/EOE/VET/DISABLED. PHS is a drug-free and tobacco-free employer with smoke free campuses.
We're Determined to Support New Mexico's Well-Being | Presbyterian Healthcare Services

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About Presbyterian Healthcare Services

Sourced by ZipRecruiter

Presbyterian Healthcare Services exists to improve the health of patients, members and the communities we serve. We are a locally owned, not-for-profit healthcare system of nine hospitals, a statewide health plan and a growing multi-specialty medical group. Founded in New Mexico in 1908, we are the state's largest private employer with nearly 14,000 employees - including more than 1,600 providers and nearly 4,700 nurses.

Industry

Hospitals

Company size

10,000+ Employees

Headquarters location

Albuquerque, NM, US

Year founded

1908

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