Payment Integrity Program Manager Jobs in Minnesota

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UMR, the largest Third-Party Administrator (TPA), a UnitedHealthcare company, is seeking an Associate Director - AI Transformation to lead business analysis and delivery governance across a portfolio of Agentic AI solutions within UMR Operations. This role will provide strategic leadership for requirements management, solution alignment, and cross-functional execution for multiple AI-enabled products focused on improving claim adjudication efficiency, payment integrity, and operational accuracy. The Associate Director will own the operating model for requirements, AI rule governance, and stakeholder coordination across technology, product, clinical, pricing, network, compliance, and payment integrity teams. This leader will supervise a team of consultants responsible for translating complex healthcare claims logic into AI-driven workflows, decision rules, and operational capabilities.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.
Primary Responsibilities: 

• Lead business analysis strategy and governance across a multi-product Agentic AI portfolio supporting claims operations (First Pass Adjudication, High Dollar Claims, Payment Integrity, Rework Automation, Reverse Quality Engine)
• Establish and standardize requirements frameworks, documentation standards, traceability models, and acceptance criteria across all AI initiatives
• Align AI solution design with business objectives by collaborating with Product, IT Architecture, Data Science, Clinical, Pricing, Network, Compliance, and Payment Integrity stakeholders
• Oversee translation of complex claims processing logic into AI-driven rules, prompts, and decision frameworks ensuring regulatory and contractual compliance
• Manage cross-workstream dependencies, integration points, and delivery sequencing across multiple AI initiatives
• Implement governance for AI rule libraries, prompt frameworks, and reusable decision components to ensure consistency and scalability across products
• Supervise and mentor a team of business analysis consultants responsible for detailed requirements elaboration and product delivery support
• Drive portfolio-level consistency and reuse of operational rules and AI decision patterns to accelerate implementation and reduce redundant build efforts
• Partner with program leadership to track value realization including improvements in cycle time, auto-adjudication rate, payment accuracy, and rework reduction
• Support stakeholder governance, executive reporting, and operational alignment across business and technology teams
• Ensure audit readiness, compliance traceability, and documentation for AI-enabled decision processes in claims operations

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in. 
 

Required Qualifications: 

• 8 years of experience in healthcare payer operations, healthcare consulting, or healthcare technology delivery
• 5 years of experience in healthcare claims operations including adjudication, payment integrity, or benefits administration
• 3 years of experience leading business analysis teams or complex transformation initiatives
• Experience leading cross-functional initiatives involving product, IT, operations, and compliance teams
• Demonstrated experience managing enterprise-level requirements strategy and governance
• Deep understanding of healthcare claims processing including eligibility and benefits, coding edits, modifiers, coordination of benefits (COB), authorization rules, bundling/unbundling, contract pricing, and adjustments
• Solid stakeholder management and executive communication skills
   

Preferred Qualifications: 

• Experience implementing AI, automation, or decision intelligence solutions within healthcare payer operations
• Experience with payment integrity programs, claims editing platforms, or healthcare pricing systems
• Experience working with large payer organizations or third-party administrators
• Knowledge of Agentic AI frameworks, prompt design, or rule-based automation in operational workflows
• Familiarity with Agile or product-based delivery models in enterprise technology environments

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.  

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $112,700 to $193,200 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.    

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.      

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.