Senior Consultant Business Systems – Medicare, Medicaid

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 Lead Business Analyst will provide strategic and operational leadership in driving business analysis initiatives across US healthcare claims operations. The role focuses on problem solving, revenue impact identification, stakeholder leadership, and domain expertise, with responsibility for guiding analysts and influencing business decisions.

Primary Responsibilities:

• Lead end‑to‑end business analysis efforts across claims adjudication, appeals, audit recovery, and FWA programs
• Drive revenue‑based opportunity identification, including overpayment recovery, underpayment detection, and leakage prevention
• Serve as the primary liaison between business leadership, SMEs, and technical teams
• Provide thought leadership in interpreting healthcare policies and translating them into executable business rules
• Mentor and guide Business Analysts, ensuring quality, consistency, and best practices in analysis and documentation
• Lead complex problem‑solving initiatives and root cause analysis for high‑impact issues
• Review and validate functional requirements, data mappings, and solution designs
• Participate in strategic planning, roadmap discussions, and prioritization exercises
• Support audits, regulatory inquiries, and leadership‑level reporting
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regard to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

• Undergraduate degree or equivalent experience
• 10+ years of experience with Business system analysis with Health care knowledge
• Experience leading cross‑functional initiatives and junior analysts
• Solid leadership and decision‑making skills, with the ability to influence stakeholders
• Deep expertise in at least one healthcare segment:
  • Medicare
  • Medicaid
  • State healthcare programs
  • US Commercial healthcare
• Extensive experience in:
  • Claims adjudication
  • Appeals and case processing
  • Audit recovery operations
  • Fraud, Waste, and Abuse (FWA / FWAD)
• Proven ability to identify and quantify revenue and financial impact

• Solid problem‑solving, analytical, and presentation skills

   

Preferred Qualifications:

• Experience in a Lead BA, SME, or Product Owner role.
• Experience supporting AI, automation, or advanced analytics initiatives in healthcare
• Solid understanding of healthcare regulatory and compliance frameworks

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.

#NJP #NIC