Remote Fraud Jobs in Minnesota (NOW HIRING)

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.

This role serves as a Program Integrity subject matter expert within Optum's Go To Market organization, supporting growth and renewal strategies for the State Government Program Integrity services and software portfolio. The role partners across market, growth, product, operations, and external business teams to shape client-specific solutions, support sales execution, inform pricing and value story development, and ensure proposals and contracts reflect the right solution mix and business priorities. The role also provides voice-of-customer input to guide new solution concepts, target customer strategy, and product launch readiness.

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:

• Partner with market, growth, product, operations, and external business partners to support growth, renewal, and strategic initiatives for Optum's Program Integrity services and software portfolio
• Develop and present client-specific solutions, including solution mix, pricing approach, value story, implementation considerations, and contract lifecycle support
• Drive execution for new sales opportunities, renewals, RFP responses, sales presentations, software demonstrations, pricing models, and complex vendor or tri-party agreements
• Provide Program Integrity expertise to support business partner integration questions, customer requirements, and cross-functional solution design
• Capture voice-of-customer insights, assess target customer opportunities, review new solution concepts, and support launch readiness for new products and services
• Lead multi-year programs and executive-priority initiatives, including project planning, stakeholder alignment, implementation strategy, and outcome tracking
• Apply analytical and financial problem-solving to large, complex clients, including savings targets, budget and forecasting inputs, and medical or administrative savings opportunities
• Manage key stakeholder relationships before and after implementation to ensure internal and client needs are addressed
• Document processes, procedures, workflows, and client- or system-specific tracking requirements
• Perform solution assessments to identify opportunities within specific accounts and recommend actions aligned to business objectives
• Ensure contracts are reviewed appropriately and represent the best interests of the business

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:

• Program integrity, fraud, waste and abuse, compliance, auditing, investigations, claims, coding, or payment integrity certification, such as AHFI, CFE, CHC, CPCO, CPMA, CPC, or equivalent
• 7 years of Program Integrity or Payment Integrity experience, including program management or solution execution
• 5 years of experience with Medicaid agency, MFCU, or health plan experience across investigations, claims processing, IT, or facility contract configuration
• 5 years of experience of working with healthcare regulations, compliance requirements, and reimbursement methodologies (includes DRG, APC, OCE, ESRD, CAH, CMG, RUG and RBRV)
• 5 years of experience documenting client operational and technical workflows
• Proficiency with Microsoft Office Suite
• Proven solid communication, influencing, negotiation, and financial analysis skills

Preferred Qualifications:

• 10 years of Payment Integrity experience
• Experience supporting policy decisions and executive-level discussions
• Proven success leading strategic initiatives, cross-functional teams, client relationships, and complex projects
• Advanced degree, such as MBA or MHA
• Knowledge of emerging payment integrity trends, technologies, platforms, and services, including claims, Medicaid, and Program Integrity systems
• Claims Platform experience: Facets, QNXT, HealthRules Payer, iKaClaims, Epic Tapestry, 3M, RAM HealthSuite, Conduent
• PI services experience: Cotiviti, Zelis, HealthEdge Source, Machinify, Lyric, Gainwell/HMS, EXL, Myers and Stauffer, Conduent, Deloitte, Accenture, Public Consulting Group, Performant, LexisNexis, or Codoxo
  

*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 $134,600 - $230,800 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.