M3P Elections and Enrollment - Sr Business Analyst - 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.

* * * If candidate resides within 30 minutes of Eden Prairie, MN or Washington, DC, the role will be hyrbid and required to work in the office 4 days per week * * *

The Sr. Business Analyst (M3P Elections & Enrollment) will support the Medicare Prescription Payment Plan (M3P) Election Management function within pharmacy benefit management (PBM) operations. As part of this team, you will play a critical role in ensuring the accuracy and integrity of member elections (opt-ins, opt-outs, renewals, and involuntary terminations) across multiple clients and systems, including enrollment management platforms, claims adjudication systems, and billing engines. You will be responsible for election issue investigation and resolution, client-facing coordination, process documentation, and data validation - contributing directly to CMS compliance, member experience, and operational excellence.

We are a key support team focused on the accuracy of member enrollment, election processing, and communications - taking care to identify areas of risk and closing gaps where members may be negatively impacted. Strategically, we are poised to proactively develop and maintain policies and procedures that deliver consistently superior performance, encourage objective measurement and results, and support an environment of continual improvement. The ideal candidate is able to recognize problems and opportunities, apply a repeatable approach to solutioning, and deliver consistent value.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities:

• Election Issue Management & Resolution
  • Manage and resolve M3P election-related tickets and service requests (incidents, inquiries, provisioning requests), ensuring documentation, tracking, and resolution within established SLAs
  • Investigate and resolve election discrepancies across systems, including Medicare Beneficiary Identifier (MBI) mismatches, group/plan ID misalignments, enrollment sync issues, and retroactive election corrections
  • Coordinate with IT and cross-functional partners to identify root causes and drive remediation for systemic election processing errors (eg, opt-out/opt-in timing issues, duplicate member profiles, eligibility sync failures)
  • Support CMS MARx transaction and PDE gap file analysis, as well as HPMS report validations related to elections and enrollment
• Election Processing & Data Validation
  • Process and validate API and batch election file loads for multiple health plan clients, including reviewing load reports for errors, rejections, and trends
  • Monitor and manage the election request queue within the enrollment management platform, addressing records with statuses such as missing signature, missing information, and eligibility mismatches
  • Perform member eligibility research using enrollment, claims, and billing systems to verify election records, plan assignments, and enrollment timelines
  • Support regression testing and production validation for system releases, including pre-, during-, and post-deployment testing activities
• Client Coordination & Communication
  • Serve as a key point of contact for client-facing election and enrollment inquiries, including recurring status meetings with health plan partners
  • Collaborate with account management and client teams to resolve batch file errors, onboard new clients to API/batch election processes, and ensure client readiness during the Annual Enrollment Period (AEP)
  • Identify coaching opportunities for call center representatives and downstream teams to reinforce correct election methods and CMS compliance
• Process Documentation & Continuous Improvement
  • Create, update, and maintain standard operating procedures (SOPs) and job aids for key election processes, including batch processing, mail-in election submissions, election queue monitoring, error report review, and CMS audit documentation
  • Contribute to key controls initiatives by establishing end-to-end visibility into all election and enrollment data streams, documenting how data is received, stored, and validated, and establishing quality assurance (QA) controls
  • Support cross-training initiatives to enable enrollment and eligibility team members to independently resolve issue management tickets across functional areas
• Reporting & Analytics
  • Prepare and deliver operational reports (eg, monthly business review reports) with metrics on ticket volumes, turnaround times, error categories, and election request trends
  • Support the development and maintenance of dashboards to track election volume, error rates, SLA compliance, and client performance scorecards
  • Leverage project management and workflow tracking tools for workload management, project tracking, and operational reporting

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:

• 3+ years of experience in business analysis, enrollment/eligibility operations, or healthcare operations
• Experience evaluating business processes, identifying gaps, and driving process improvement
• Proficiency with IT service management (ITSM) or ticketing platforms (eg, ServiceNow, Jira, Remedy)
• Proven solid analytical skills with the ability to research and resolve complex member-level data discrepancies across multiple systems
• Proven excellent written and verbal communication skills, including the ability to draft polished client-facing communications and SOPs
• Demonstrated ability to manage multiple priorities and meet deadlines in a fast-paced environment

Preferred Qualifications:

• Experience with Medicare Part D programs, CMS regulations, and M3P or similar election/enrollment programs
• Experience working wtih RXclaim
• Experience building or contributing to dashboards in Power BI, Tableau, or similar business intelligence tools
• Experience with cross-functional coordination across IT, compliance, account management, and client-facing teams
• Familiarity with pharmacy benefit management (PBM) systems and election processing workflows (API, batch file, paper/mail, phone, web portal)

• Knowledge of CMS audit requirements, MARx reporting, PDE submissions, and HPMS processes

*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 - $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.