We’re evolving health care so everyone can have the opportunity to live their healthiest life. It’s why we put your unique needs at the heart of everything we do, making it easy and affordable to manage health and well-being. We are delivering the right care how and when it’s needed; providing support to make smarter and healthier choices; and making prescription services easier, while helping you save money along the way. It’s everything health care should be. Together, for better health.

Optum is part of UnitedHealth Group (NYSE: UNH).

Primary Responsibilities:

Develop and manage a portfolio of cost savings initiatives with measurable client impact

Lead conceptualization to completion of analytics projects and product development efforts

Perform iterative analytical and investigative work to support concept development and solution validation

Establish and maintain matrixed relationships with internal stakeholders to align and deliver payment integrity initiatives

Influence senior leadership to adopt innovative ideas, approaches, and products

Recommend changes to product development based on market research and emerging trends

Serve as an industry thought leader and SME in professional and facility medical claims, pricing, and cost management

Create specifications for data structuring, product modeling, and dashboard development

Deliver activity and value analytics to clients and stakeholders using BI and statistical tools

Use tools such as Excel, SQL, SAS, Tableau, and PowerPoint to build solutions and communicate insights

Act as a company thought leader and functional SME

Provide a broad business perspective and support senior leadership

Develop pioneering approaches to emerging industry trends

Lead cross-functional collaboration and influence without direct authority

Required Qualifications:

5+ years of experience in healthcare claims lifecycle (submission, processing, adjudication, payment)

3+ years auditing, billing, and/or coding claims

3+ years in the healthcare industry (Medicare, Medicaid, Commercial, Behavioral Health, Home and Community) with deep exposure to Payment Integrity

2+ years in consultative roles with cross-functional collaboration

2+ years interpreting data sets and presenting proposals to stakeholders

2+ years of project management experience

Working knowledge of CMS rules, billing codes, and related services

Advanced proficiency in Excel (pivot tables, formulas, charts)

Proven solid analytical mindset, critical thinking, and communication skills

Proven ability to lead without authority in high-paced environments

Preferred Qualifications:

An undergraduate degree is solidly preferred, an advanced degree in healthcare or medical field a plus

Coding certification (AAPC or AHIMA)

2+ years in claims adjudication or revenue cycle management

1+ years in matrixed, adaptive environments with tight deadlines

Proficiency in SQL, SAS, and other statistical programs

Proficiency in Visio, Tableau, PowerPoint

Proven solid project management and problem-solving skills

Proven exceptional presentation, communication, and negotiation abilities