Consultant Business Systems

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.

We are seeking a Business Systems Analyst (Salary Grade 27) to support high-impact initiatives in Payment Integrity (PI) and Defensive AI. This role will play a critical part in identifying, defining, and enabling solutions that detect and prevent Fraud, Waste & Abuse (FWA) and improve the accuracy and efficiency of claims processing.

You will act as a bridge between business, analytics, data science, and engineering teams, translating complex business problems into scalable system and AI-driven solutions that protect enterprise value and improve healthcare outcomes.

Primary Responsibilities:

• Business & AI Requirements Management
  • Elicit, analyze, and document business, system, and AI/analytics requirements
  • Translate business problems into data-driven use cases, rules, and AI model requirements
  • Develop functional specifications, user stories, and process flows
  • Validate requirements with stakeholders and ensure alignment with business goals
• Defensive AI & Payment Integrity Enablement
  • Support development of FWA detection strategies, signals, and rules
  • Translate business scenarios into pre-pay/post-pay intervention logic
  • Partner with data science teams to define AI model inputs, outputs, and validation criteria
  • Analyze gaps in detection and contribute to Defensive AI roadmap and enhancements
• Solution Design & Delivery
  • Collaborate with technology and product teams to design end-to-end system and AI-enabled solutions
  • Support system integration, workflow design, and data mapping across claims and analytics platforms
  • Participate in Agile delivery (sprint planning, backlog refinement, demos)
  • Support UAT, defect triage, and release readiness
• Data Analysis & Insights
  • Perform deep data analysis on claims, providers, and operational data to identify trends and anomalies
  • Support development of dashboards, reports, and insights for business decision-making
  • Ensure data quality, traceability, and governance compliance
• Stakeholder Engagement
  • Serve as a liaison across business, product, AI/analytics, and engineering teams
  • Facilitate workshops and working sessions to drive clarity on complex problems
  • Communicate insights, risks, and opportunities effectively to leadership and stakeholders
• Process Improvement & Innovation
  • Identify opportunities for automation, digitization, and AI-driven improvements
  • Support initiatives to shift-left detection, reduce leakage, and improve operational efficiency
  • Contribute to innovation efforts in real-time detection and intelligent decisioning systems
• 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:

• Bachelor's degree in Engineering, Technology, Business, or related field
• 4+ years of experience in Business Analysis / Systems Analysis
• Experience in:
  • Requirements gathering and documentation
  • Data analysis and business process mapping
  • Stakeholder collaboration in cross-functional teams
• Proven solid analytical and problem-solving skills

Preferred Qualifications:

• Experience in Payment Integrity, Claims Processing, or Healthcare domain
• Experience with SQL, Excel, or BI tools
• Experience in Agile/Scrum delivery models
• Exposure to Fraud, Waste & Abuse (FWA) detection or analytics
• Knowledge of AI/ML concepts and analytics-driven solutions
• Familiarity with claims platforms, APIs, or enterprise data systems

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.