Member Issue Resolution Analyst

Optum intro standard 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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

As a Member Issue Resolution Analyst, you will be responsible for investigating and resolving complex member claim issues across multiple processing entities. This role requires strong analytical skills to identify discrepancies, determine root causes, and implement solutions that prevent recurring issues while ensuring a positive member experience.

You will play a key role in reducing member inquiries by partnering with internal teams and external entities to improve accuracy, minimize member disruption, and enhance the overall member experience within delegated arrangements.

About the Team:

The VBR Operations - Member Issue Resolution team operates in a highly collaborative, fast-paced environment focused on solving complex, cross-system issues that impact members. The team partners closely with internal business areas and external entities to drive accountability, improve processes, and deliver sustainable solutions.

We emphasize proactive problem-solving, continuous improvement, and a shared commitment to improving the member experience across delegated and value-based care models.

Primary Responsibilities:

• Review and resolve complex member claim issues end-to-end across multiple systems, taking full ownership from identification through resolution and prevention
• Resolve escalated and regulatory-driven issues across lines of business and claims platforms, meeting established turnaround times, quality, and performance expectations
• Analyze patterns and trends in claims processing and cost share application to identify systemic issues and opportunities for improvement
• Partner with internal teams and external entities to correct processing errors, implement corrective actions, and improve overall accuracy
• Partner with the Cost Share team to support resolution of cost share issues, ensuring accurate application and understanding of member impact
• Identify and communicate opportunities for process improvement and automation, documenting findings and driving solutions that reduce issue volume
• Review member inquiries holistically, resolving the immediate issue while identifying and addressing additional impacts to the member
• Group and address similar issues within inventory to drive efficient, scalable resolution
• Communicate findings, recommendations, and risks clearly to internal and external stakeholders to enable timely resolution and prevention

What Success Looks Like

• Independently resolves complex issues with minimal guidance
• Identifies root causes - not just symptoms - and drives sustainable fixes
• Applies analytical and creative thinking to solve ambiguous or non-routine problems
• Proactively identifies risks and improvement opportunities without direction
• Navigates complexity across systems, teams, and processes effectively
• Delivers solutions that improve the member experience and reduce repeat issues

Required Qualifications:

• Bachelor's degree or equivalent healthcare operations experience
• 3+ years of experience in claims operations, issue resolution, or healthcare servicing
• Experience handling complex, multi-system claim issues
• Demonstrated ability to perform root cause analysis and drive resolution independently
• Solid analytical and problem-solving skills with the ability to think beyond standard processes
• Proficiency in Microsoft 365 tools (Excel, Word, PowerPoint, Teams, SharePoint, etc)
• Ability to manage competing priorities in a fast-paced environment
• Effective written and verbal communication skills
• Ability to work independently and collaboratively, with a proactive approach to identifying and resolving issues
• Ability to navigate ambiguity, learn quickly, and apply new concepts across evolving systems and processes

Preferred Qualifications:

• Experience with Cosmos, USP Cirrus, CSP Facets, or ATS
• Deep knowledge of delegated claims and value-based care models
• Experience working with risk entities or delegated providers
• Exposure to process improvement, automation, or continuous improvement

Please note you must currently be eligible to work and remain indefinitely without any restrictions in the country to which you are making an application. Proof will be required to support your application.

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.

Diversity creates a healthier atmosphere: Optum is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to gender, civil status, family status, sexual orientation, disability, religion, age, race, and membership of the Traveller community, or any other characteristic protected by law. Optum is a drug-free workplace. © 2025 Optum Services (Ireland) Limited. All rights reserved.

#BBMEMEA