Senior Claims Business Process Analyst

This position is Remote in Pacific Time Zone . You will have the flexibility to work remotely* as you take on some tough challenges. 

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.

Flexible, Friendly, Fast on your feet, that’s a great start. Accurate, Accountable, Self Directed, These traits can take you places. Our claims operations are the focal point of handling information about services patients receive and they way those services get paid. It’s complex, detailed work. It’s fast paced challenge. It’s a job that calls on you to be thoughtful, resourceful, team-driven and customer-focused. To put it mildly, there is never a dull moment. Senior Claims Business Process Analysts are responsible for all related aspects of claim system processes and claim business rules. Include claims systems utilization, capacity analyses/planning and reporting, claims-related business and systems analysis. Ensure data integrity, data security and process optimization.

This position is full time, Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:30am – 4:00pm. It may be necessary, given the business need, to work occasional overtime.

We offer 1-2 weeks of on-the-job training. The hours of the training will be based on schedule or will be discussed on your first day of employment.

 

Primary Responsibilities:

• Responsible for providing research and root cause analysis for claim quality remediation
• Perform capacity planning and reporting
• Responsible for all aspects of quality assurance
• Create and edit requirements, specifications, cost benefit analysis and recommendations to proposed solutions
• Facilitate development of process documentation
• Follow standard programming guidelines and requirements as set by team
• Standard documentation and tracking processes
• Uses pertinent data and facts to identify and solve a range of problems within area of expertise

 

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:

• High School Diploma / GED
• Must be 18 years of age OR older
• 2 + years of experience analyzing and solving customer problems in an office setting environment
• Ability to multi-task, this includes ability to understand multiple products and multiple levels of benefits within each product
• Moderate proficiency with computer and Windows PC applications, which includes the ability to learn new complex computer system applications
• Ability to work, Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 7:30am – 4:00pm.

 

Preferred Qualifications:

• 3+ years in a technical or metrics based environment ; preferably claims and/or customer service
• 2+ years PBM pr Healthcare experience
• 1+ years of RX COMET experience
• Experience creating or editing Macros
• SharePoint development/creation
• Intermediate level in Microsoft Suite

 

Telecommuting Requirements:

• Reside within Pacific Time Zone
• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

 

*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 hourly pay for this role will range from $23.41 – $41.83 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

 

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.

 

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