This position is National Remote. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. For all hires in Minneapolis, Virginia, Maryland, or Washington, D.C. area, you will be required to work in the office for a minimum of four (4) days per week.

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 health care system needs to evolve even further than it has, and it must do so at a lightning-fast pace. New models of care and networks of providers are emerging now to better serve patients and communities, and at UnitedHealth Group, we are playing a lead role. As a Recovery Resolution Analyst Senior within our Payment Integrity team, you will support the growth of our markets and membership. In return, you’ll discover the impact, resources, backing, and opportunities that you’d expect from a Fortune 5 leader.

This position is full-time, Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 6:30pm EST. It may be necessary, given the business need, to work occasional overtime.

We offer weeks of on-the-job training. The hours of the training will be based on schedule or will be discussed on your first day of employment.

Primary Responsibilities:

• Monitor and analyze inventory overturn and true positive rates
• Root cause analysis of savings anomalies with formal presentations for sr. leadership
• E2E implementation of new concepts and programs utilizing governance framework
• Establishing savings methodologies and associated reporting and dashboard needs
• Analyzing business processes for improvements to deliver shift left strategies, faster TAT, & increased quality
• Developing and maintaining business policy and procedure documentation and control plans
• Recovery submissions for overpayments and claims ops liaison / partnership
• Identifying and delivering automation opportunities through process demonstrations, process mapping, and UAT
• Liaison with data team to identify and introduce technology to enable business performance
• Complete suite of reconsideration work across Payment Integrity enabling accurate claims payment and identifying over and underpayments

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
• Must be 18 years of age or older
• 3+ years of healthcare operations experience within health plan or managed care business
• 3+ years of payment integrity experience: prepayment and/or post-payment processes
• 2+ years of experience identifying automation opportunity, writing requirements, and UAT
• 2+ years of experience in DMAIC problem-solving techniques including root cause analysis
• Intermediate Office (Excel, PowerPoint, Visio) experience
• Independent problem-solving skills
• Ability to lead and influence business partner meetings and relationships
• Ability to regularly shift large priorities while maintaining deadlines
• Ability to work full-time, Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:00am – 6:30pm EST. It may be necessary, given the business need, to work occasional overtime.

Preferred Qualifications:

• Experience in Coordination of Benefits, Data Mining, OPRS, FWAE, PAS, CES, or ACE
• Experience in claims payment platforms EZCap, IDX, and/or Epic Tapestry
• Experience in CA DHCS and DMHC
• Experience analyzing business processes to develop shift-left strategies
• Developing E2E process documentation and controls
• Savings forecasting and methodology development

Telecommuting Requirements:

• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

*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 hourly pay for this role will range from $28.27 – $50.48 per hour 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.