Claims Business Process Analyst Senior

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.

Primary Responsibilities:

• Review and resolve complex cases with an end to end mindset to prevent issues or inquiries from recurring. Scope open inventory for like issues for cases worked to group and resolve batches.
• Demonstrate a knowledge of end-to-end processes of multiple different types of capitated and delegated arrangements within the Value Based Care Model
• Identify and articulate trends occurring within a risk entity or across multiple risk entities within claims processing and cost share application
• Identify and articulate trends with our assigned delegates with the Sr. Issue Resolution Analyst and partner to work towards shift left initiatives
• Partner and collaborate internally and with Risk Entities to correct claims processing and cost share application errors to prevent recurring issues. Actively participate in meetings with cross functional areas aligned by risk entities to share findings
• Identify and communicate opportunities for improving issue resolution processes, including automation. Clearly document findings and solutions for trended issues after performing root cause analysis
• Perform reconciliation of member inquiry cases, respond to the specific issue of the inquiry, as well as review for and resolve other issues that may be present for the member, outside of the inquiry
• Support and communicate with the Sr. Issue Resolution Analyst assigned to your Delegate. Perform root cause and trend analysis of issues by assigned Delegate. Clearly document findings and solutions to prevent future issues
• Communicate effectively (both written and verbal) with business partners
• Manages emotions effectively in high-pressure situations, maintaining composure, and fosters a positive work environment conducive to collaboration and productivity
• 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 regards 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:

• Degree or equivalent data science, analysis, mathematics experience
• Experience supporting operational teams’ performance with reports and analytics 
• Experience using Word (creating templates/documents), PowerPoint (creation and presentation), Teams, and SharePoint (document access/storage, sharing, List development and management)
• Basic understanding of reporting using Business Insights tools including Tableau and PowerBI
• Expertise in Excel (data entry, sorting/filtering) and VBA
• Proven ability to work across lines of business, claims platforms and on service provider/Delegate issues as needed
• Proven solid communication skills including oral, written, and organizational skills

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.

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