Telecommute Claims Adjudicator Jobs (NOW HIRING)

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.  

The Epic Tapestry Claims Analyst is responsible for the configuration, maintenance, and optimization of Epic Tapestry Claims and integrated thirdparty applications that support claims processing, benefits administration, and payer operations. This role ensures stable, compliant, and highquality system performance across the claims ecosystem, with a strong focus on configuration accuracy, workflow alignment, and timely resolution of operational issues. The analyst partners closely with business stakeholders, technical teams, and vendors to support ongoing enhancements, break/fix activities, and regulatory updates.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

Epic Tapestry Claims Configuration & Support

• Configure, maintain, and optimize Epic Tapestry Claims components, including benefit plans, claims adjudication rules, provider contracts, fee schedules, accumulators, and related workflows
• Analyze and troubleshoot claims processing issues, identifying root causes and implementing sustainable solutions
• Support upgrades, releases, and environment changes, ensuring claims configuration remains accurate and compliant
• Collaborate with operational leaders to translate business requirements into system configuration and functional design

ThirdParty Application Management

• Manage the setup, configuration, and ongoing support of integrated thirdparty applications used for claims processing, clearinghouse functions, eligibility, payment integrity, and related services
• Coordinate with vendors on interface behavior, data mapping, file formats, and issue resolution
• Monitor application performance, data flows, and integration points to ensure accuracy and reliability
• Maintain documentation for system configuration, integration specifications, and operational procedures

Operational Support & Service Management

• Use ServiceNow for incident management, break/fix work, change requests, and release coordination
• Prioritize and resolve tickets within established SLAs, ensuring clear communication with end users and stakeholders
• Participate in oncall rotation or afterhours support as needed for critical issues or deployments
• Support change management processes, including impact analysis, testing, validation, and production migration

Collaboration & Stakeholder Engagement

• Partner with Claims Operations, Revenue Cycle, Managed Care, and IT teams to ensure system alignment with business needs
• Provide subjectmatter expertise for projects, enhancements, and regulatory initiatives
• Participate in crossfunctional design sessions, workflow reviews, and optimization efforts

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:

• Epic Tapestry Certification (Claims or closely related module)
• 3 years of handson experience supporting Epic Tapestry Claims configuration and/or claims processing systems
• 3 years of experience managing or supporting thirdparty integrated applications in a healthcare or payer environment
• 3 years of experience in claims adjudication, benefit structures, provider contracts, and payer workflows
• 3 years of experience with ServiceNow or similar ITSM platforms for incident, problem, and change management
• 3 years of experience analyzing complex data flows, troubleshoot integration issues, and interpret EDI transactions (e.g., 837, 835, 270/271)

Preferred Qualifications:

• Experience with Epic Bridges, EDI, or interface engines (e.g., Corepoint, Rhapsody, Mirth)
• Experience supporting regulatory or compliancedriven system changes
• Background in managed care, payer operations, or revenue cycle
• Familiarity with SQL, reporting tools, or data analysis techniques

Soft Skills:

• Excellent communication skills and the ability to work effectively with both technical and nontechnical stakeholders

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. 

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.

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