Senior Business Systems Analyst - CES

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.

Title: Application Managed Services (AMS) Rule Developer

As a Rules Developer you will support the Optum Application Managed Services (AMS) Team. The AMS team engages in long term commitments and partnerships.

AMS provides full-service operation to our clients with a proactive approach to business communication, growth and problem resolution. The AMS team partners with health plan clients to become an extension of their organization. The highly seasoned staff is dedicated to managing Claims Edit System (CES) as well as looking at where CES fits in the client's "Ecosystem". AMS provides services that will help provide long term benefit for the client, not only direct savings, and increased revenue but also savings in process, manual effort and other operational areas.

The Rule Developer role requires a highly flexible and adaptable skillset with the ability to handle periods of stress and/or heavy workloads. Solid experience as a Developer, rule writing, writing complex SQL/Oracle queries, or a similar role is required, preferably with demonstrated experience with healthcare claims or Medical /Drug/ reimbursement policies. The Rule Developer must have the ability to not only participate in meetings but also drive to effective solutions, while producing Rules based from detailed client requirements and other required supporting materials. This position requires the ability to communicate well between technical and non-technical personnel. The ability to adeptly navigate ever changing priorities is also a key skill of the Rule Developer. Additionally, the role requires each Rule Developer to become a Subject Matter Expert. The Rule Developer primarily works independently however is also expected to work collaboratively across teams and the organization to support our client's needs and meet their affordability and saving's targets.

Primary Responsibilities:

• Participant in the "Rule Approval" process
• Collaborate with Rules Business Analyst in evaluating business requirement and prepare detailed functional and technical specifications
• Design and develop simple to complex rules in Claims Edit System (CES)
• Conduct Unit Test of rules with the goal of zero defects before hand-off to the Integration Tester
• Prioritize and manage business requirements in an effort to minimize scope issues
• Define, document, and communicate system requirements, as related to CES and custom rule development
• Diagnose root causes of rule / system defects/issues and collaborates with appropriate functional areas develop solutions
• Documentation of customer business processes, workflows, and requirements as they relate to issues identified by a development initiative
• Review and contribute to overall QC/QA of test plans
• Define, use and communicate design patterns and best practices in service-oriented analysis, design and development
• Collaborate with Integrated testing team to ensure testing efforts align with system deliveries and business processes
• Contributor to AMS Community: Ask an Expert, provides feedback for updated content - works with lead/owner of the committee
• Building out the rule library: feed information to client teams for updated information, etc.
• Communicate design to all stakeholders and varying levels of the organization
• Present and evaluate design solutions objectively and facilitate conflict resolution
• Identify opportunities to improve processes, customer engagement, and add client value to maintain and grow the business relationship
• 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 regard 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:

• 3+ Experience with business/technical requirements and test case development
• 3+ Experience with healthcare claims or Medical /Drug/ billing and reimbursement policies
• 1+ years of experience interfacing at the Executive level
• 1+ year of user acceptance testing experience or equivalent knowledge
• Experience in the delivery of complex technology solutions that address business issues within a large fast paced environment
• Ability to bridge technical requirements and business needs to help drive solutions for our customers
• Proficiency with MS Office applications

Preferred Qualifications:

• Bachelor's Degree solidly
• Undergraduate degree
• Experience in Healthcare industry, either via direct work in the market (with insurers, hospitals, physicians, etc.) or via technology solutions being sold into the healthcare market
• Experience with CES, Claims Manager or Content Manager
• Experience or Proficiency with writing SQL or Oracle queries 
• Coding experience or certified coder (AHIMA or CPC)

Soft Skills:

• Solid analytic, technical, and problem-solving skills
• Excellent interpersonal, written, and verbal communication skills
• Ability to manage multiple priorities and execute deliverables on time
• Highly motivated and innovative, with the ability to work as part of a high-performance team as well as independently
• Demonstrates outstanding time management skills
• Demonstrated competency in large-scale organizations within a matrix environment

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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