Remote Optum Utilization Review Jobs in Washington

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The Optum Serve Community Care Network (CCN) team is seeking a highly experienced Senior Healthcare Claims Analytics Analyst to support claims oversight, payment integrity, reimbursement policy analysis, and strategic analytics for the Department of Veterans Affairs (VA) Community Care program.
This role serves as a senior analytic expert responsible for managing complex claims data requests, conducting investigations, performing impact assessments, and supporting executive decision-making across a wide range of operational, financial, payment policy, and regulatory topics. The individual will partner closely with Claims Oversight, Payment Integrity, Finance, Clinical Operations, Compliance, Technology, and VA stakeholders to develop data-driven insights and recommendations.
The ideal candidate brings experience supporting large healthcare organizations, federal healthcare programs, or Veterans Health Administration (VHA) operations and has demonstrated success managing urgent executive-level data requests, coordinating analytic teams, and translating complex business questions into actionable analyses.
This position functions within the Claims Analytics & Insights capability of the Claims Oversight organization and plays a key role supporting payment policy implementation, CDI initiatives, VA inquiries, claims modernization efforts, and analytic governance activities.
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:

• Executive Analytics & Decision Support
  • Serve as a senior analytic advisor supporting leadership, Claims Oversight, Payment Integrity, and VA stakeholders
  • Manage and prioritize complex analytic requests requiring rapid turnaround and executive visibility
  • Conduct data-driven investigations related to claims processing, payment accuracy, reimbursement methodologies, provider billing patterns, and operational performance
  • Develop executive-ready reports, presentations, and briefing materials
  • Claims Analytics & Quantification
  • Perform detailed claims analyses to quantify financial, operational, provider, and member impacts
  • Evaluate claim populations, payment outcomes, trends, root causes, and reimbursement methodologies
  • Support cost, utilization, payment policy, and claims integrity analyses
  • Conduct impact assessments associated with policy changes, CDI implementation, fee schedule updates, claims edits, and reimbursement methodologies
• VA Inquiry Support
  • Support VA analytic inquiries from intake through final response
  • Translate business questions into analytic approaches and data requirements
  • Work with claims SMEs to validate findings, quantify impacts, and prepare VA-ready responses
  • Coordinate data requests across internal and external partners as needed
• Analytics Governance & Intake
  • Support development and maturation of the Claims Analytics intake and triage process
  • Help define analytic requirements, scope, methodologies, and success criteria
  • Ensure consistency, quality, traceability, and documentation across analyses
  • Support ServiceNow and intake governance processes for claims analytics requests
• Cross-Functional Collaboration
  • Partner with Claims Operations, Payment Integrity, Finance, Clinical Operations, Provider Services, Compliance, and Technology teams
  • Work closely with data engineering and analytics teams to develop queries, reports, dashboards, and monitoring tools
  • Participate in cross-functional workgroups related to payment policy implementation, claims modernization, and operational improvements
• Team Leadership
  • Provide guidance and mentorship to analysts supporting claims initiatives
  • Review analytic work products and promote analytic standards and best practices
  • Coordinate activities across multiple stakeholders and competing priorities
  • Serve as a trusted resource for complex analytic and claims data questions

Why This Role Exists

• The VA CCN environment increasingly requires rapid response to complex analytic questions involving claims payment accuracy, reimbursement policy implementation, CDI review, fee schedule changes, recoupments, provider impacts, and operational performance. Claims subject matter experts currently spend significant time gathering data, developing queries, and coordinating analyses rather than focusing on policy interpretation and operational oversight.
• This role establishes dedicated analytic capacity within Claims Oversight to:
• Support growing VA inquiry volume
• Perform large-scale claims impact assessments
• Improve response times to urgent analytic requests
• Enhance claims monitoring and reporting capabilities
• Support payment policy and CDI implementation efforts
• Reduce dependency on a limited number of SMEs
• Create a scalable Claims Analytics & Insights function aligned with mature payer operating models

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:

• 7+ years of healthcare analytics experience
• 5+ years of experience working with healthcare claims data
• Experience supporting Medicare, Medicaid, VA, TRICARE, commercial payer, or federal healthcare programs
• Advanced SQL experience
• Experience developing complex analytic methodologies and quantitative analyses
• Demonstrated ability to manage multiple high-priority requests simultaneously
• Solid written and verbal communication skills

Preferred Qualifications:

• Veterans Health Administration (VHA) experience
• Experience supporting executive leadership, Congressional/Hill inquiries, regulatory reporting, audit support, or enterprise-level operational reporting
• Experience leading or overseeing teams of analysts
• Experience responding to urgent operational data requests and executive reporting requirements
• Experience with healthcare reimbursement methodologies, payment policy analysis, and claims adjudication processes
• Experience with Palantir, Tableau, Power BI, SAS, Python, R, Databricks, or other advanced analytics platforms
• Familiarity with VA Community Care, Medicare fee schedules, payment policy, CDI, and payment integrity concepts

*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 - $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.
OptumCare 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.
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment