Optum Tech is a global leader in health care innovation. Our teams develop cutting-edge solutions that help people live healthier lives and help make the health system work better for everyone. From advanced data analytics and AI to cybersecurity, we use innovative approaches to solve some of health care's most complex challenges. Your contributions here have the potential to change lives. Ready to build the next breakthrough? Join us to start
Caring. Connecting. Growing together.
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 end-to-end business analysis efforts across claims adjudication, payment integrity reviews, appeals, audit recovery, and FWA investigations
- Drive revenue-based opportunity identification, including duplicate claims detection, pricing/contract errors, eligibility misalignment, underpayment/overpayment root causes, and leakage prevention
- Serve as the primary liaison between business sponsors, PI SMEs, actuarial partners, provider teams, and technical build teams
- Interpret healthcare guidelines, policies, contract rules, and benefit logic and translate them into actionable business rules and functional requirements
- Lead formulation, validation, and refinement of requirements, acceptance criteria, and business rule logic for PI interventions
- Review data quality, impact assessments, and financial projections across PI initiatives
- Mentor and guide Business Analysts, ensuring consistency, analytical rigor, and adherence to documentation standards
- Lead complex issue remediation: deep-dives into claim-level patterns, provider-level anomalies, pricing variances, member eligibility mismatches, and systemic process gaps
- Support leadership-level reporting, audit responses, regulatory inquiries, and controls documentation
- Participate in roadmap design, prioritization sessions, operational reviews, and cross-functional working groups
Domain & Data Expertise:
- Familiarity with Call Center datasets (member & provider contact/call data) for identifying navigation issues, provider abrasion signals, or member experience indicators tied to PI
- Experience working with Provider RCM data (billing patterns, coding, prior auth, clinical documentation alignment)
- Exposure to EHR / Clinical datasets for validating medical necessity, care patterns, and crosswalks to claims
- Experience with PI-specific reporting, including:
- Duplicate claim identification
- Pricing anomalies
- Eligibility issues & benefit mismatches
- Understanding of actuarial reporting, forecasting dashboards, or cost-of-care analytics used for PI impact sizing
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 Business Analysis experience
- 5+ years of experience supporting the healthcare domain
- 5+ years of experience in a leadership, decision-making, and stakeholder management skills
- 3+ years of experience interpreting claims adjudication rules, payment policies, or benefit structures
- Experience in Claims PI, FWA, Provider Contracting, Billing, or RCM
- Ability to work onsite in Minneapolis per Optum's hybrid policy
Preferred Qualifications:
- Bachelor's degree in Business, Health Administration, Finance, or related field
- Excellent analytical and problem-solving skills
- Exceptional written and verbal communication
- Solid time management; ability to handle multiple priorities
- Proven ability to work independently and collaboratively
- Medicare / Medicaid domain depth
- SQL for data exploration, validation, and reporting
- Familiarity with PBM, eligibility logic, or provider credentialing systems
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.
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.
