Business Analyst Consultant - Telecommute

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

Tough challenges? We know a thing or two about those. When you're on a mission to help people live healthier lives, the stakes couldn't be higher. As a Business Analyst Consultant, you will help rewrite the future of the health care system. You'll analyze data and deliver bold, business-savvy ideas to impact the lives of millions. Along with ground-breaking challenge, you'll have the support and resources of a Fortune 5 company. Join us.

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

Primary Responsibilities:

• Implementation and management of payment integrity programs


• Investigating, reviewing, and providing claims expertise/judgement in the application of correct billing and medical appropriateness of services


• Analyze, review, forecast and trend complex data


• Develop and implement effective/strategic business solutions through research and analysis of data and business processes


• Support short- and long-term operational/strategic business activities through analysis


• Manage working relationships with multiple Payment Integrity vendors.

Are you up for navigating a complex matrix of business units and teams? We share a near obsessive desire to outperform and outdo our own achievements across our entire global business landscape. It's going to take all you've got to create valuable solutions to improve the health care system.

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:

• High school diploma, GED, or equivalent work experience


• 5+ years of experience in the health insurance industry: in auditing, claims processing, payment integrity, claims configuration


• 2+ years of experience conducting or managing comprehensive research to identify billing abnormalities, questionable billing practices, irregularities, and fraudulent or abusive billing activity


• 2+ years of experience using claims platforms such as UNET, Pulse, NICE, Facets, Diamond, etc.


• Experience with Fraud, Waste, & Abuse (FWA) programs, or working with a Special Investigations Unit (SIU)


• Experience with public speaking and presenting to large audiences, including Executives and Medical Directors


• Experience interpreting provider contractual agreements


• Proficiency in performing financial analysis/audit, including statistical calculation and interpretation


• Proficiency in various claims payment methodologies; to include capitation, fee-for-service, DRG, percent-of-charge, and OPPS


• Proficiency using Microsoft Office: Word, Excel (data analysis, sorting/filtering, pivot tables), PowerPoint (prepare formal presentations and training), Visio (develop workflow processes)

Preferred Qualifcations:

• Undergraduate degree


• Experience working with state and federal contracts


• CES (Claims Editing System) SME, or SME in another clinical claims editing system, or experience in various other payment integrity programs


• Experience with product and vendor implementations


• Experience managing staff

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $82,100 to $146,900. The salary range for Connecticut / Nevada residents is $90,500 to $161,600. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Recommended Skills

• Auditing
• Billing
• Business Processes
• Business Strategies
• Claim Processing
• Clinical Works