Healthcare Economics Consultant, Risk Adjustment - Remote

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.  

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Support monthly and quarterly revenue forecasting processes under direction of senior analysts and managers
• Assist in validating data inputs, reconciling outputs, and documenting key assumptions and changes
• Work with large healthcare datasets using SQL and Excel to manipulate, extract, and analyze data
• Collaborate with data engineering and finance teams to ensure accurate and timely data availability
• Help build and refine standardized forecast models and dashboards
• Interpret CMS Risk Adjustment model logic and incorporate changes into existing templates
• Participate in data validation, forecast review sessions, and documentation efforts
• Present findings and insights in a clear and concise manner to internal stakeholders
• Learn risk adjustment methodologies, forecasting techniques, and CMS specifications through project work and team mentorship
• Positions in this function research and investigate key business problems through quantitative analyses of utilization and healthcare costs data. Provides management with statistical findings and conclusions. Identifies potential areas for medical cost improvements and alternative pricing strategies. Provides data in support of actuarial, financial and utilization analyses
• Generally work is self-directed and not prescribed
• Works with less structured, more complex issues
• Serves as a resource to others

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:

• Undergraduate degree or equivalent experience.
• 1+ years of experience working with healthcare or financial data in a business or academic setting
• Experience with Medicare Advantage data files such as MMR, MOR, and MAO-004 reports through academic or professional experience
• Intermediate proficiency in SQL
• Proven solid Microsoft Excel skills (e.g., PivotTables, SUMIFS, VLOOKUPs)
• Ability to manage multiple tasks and meet deadlines with attention to detail

Preferred Qualifications:

• Demonstrated familiarity with Medicare Advantage or healthcare revenue forecasting
• Hands-on experience working with CMS files such as Monthly Membership Report (MMR), Medicare Advantage Outbound Reconciliation (MOR), or MAO-004 submission/return files
• Experience working in Snowflake or similar modern data platforms
• Exposure to data visualization tools and reporting (e.g., Tableau, Power BI)
• Proven solid written and verbal communication skills
• Demonstrated willingness to learn and grow into more advanced forecasting and modeling roles

*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 salary for this role will range from $72,800 to $130,000 annually 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.