Recovery Resolution Consultant

This position is National Remote. You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.

About the Role:
In healthcare, evolution doesn’t just happen. It takes innovation, imagination, and a passion for solving problems in new and better ways. And innovation is taking place at a lightning-fast pace every day at Optum.

As the fastest growing part of the UnitedHealth Group family of businesses, we’re expanding our team and creating excellent opportunities for those who want greater purpose and more impact in their work. We’ll provide investment, support, and resources to advance your career. You’ll provide the talent, ambition, and drive.

Join our Competitive Intelligence team, part of the Ideation and Growth group, where we focus on uncovering market trends in payment integrity and medical spending to drive new business and cost-saving opportunities. As a Business Analyst, you’ll collaborate with exploratory auditors and data analysts to transform early-stage concepts into scalable, data-driven solutions. This role involves conducting investigative research, and performing targeted data analysis to assess the viability of new initiatives.

General Profile:

• Process orientated
• New concept ideation
• Growth mindset
• Quality review across a range of themes
• UNET Platform knowledge
• Excellent relationship management  
• Industry Knowledge

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 8:00 am - 5:00 pm EST.

This will be on the job training and the hours during training will be normal business hours, Monday - Friday.

Primary Responsibilities:

• Conduct root cause analysis for insourcing concepts including research / verification of identified claims
• Performs complex data and conceptual analyses
• Project delivery
• Requirements documents including user stories / BRDs
• Testing and quality management including production of test plans and scripts
• Ability to translate business requirements and acumen to a technical audience
• Operational readiness including preparation of operational documentation and training
• Serves as a key resource on complex and / or critical data issues
• Supporting cross value stream transformation and growth activities, both complex and varied

Job Scope and Level Guidelines:

• Ability to distill criteria for data analysis
• Translates concepts into practice
• Assesses and interprets customer needs and requirements
• Ensure adherence to state and federal compliance policies, reimbursement policies, and contract compliance
• Use pertinent data and facts to ideate, identify and solve a range of problems within area of expertise
• Examine, assess, and document business operations and procedures to ensure operational efficiency and excellence

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
• 3+ years of experience with researching medical claims, including provider contract, claim payment policies and regulatory review
• 3+ years of hands-on experience with reviewing and pricing E&I UNET claims
• Experience with analyzing large data sets to determine trends / patterns
• Experience with project delivery and execution
• Ability to work any shift between the hours of 8:00 am - 5:00 pm EST from Monday - Friday

Preferred Qualifications:

• Experience with analyzing business processes and workflows, providing evaluations, benchmarks, and process improvement recommendations
• Experience in KPI management and reporting
• Experience with using SQL and Microsoft Excel
• Experience with using CDB, iBaaG, iCUE, Doc360 / Emptoris, ODAR, Claim Miner, COW

Telecommuting Requirements:

• 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

Soft Skills:

• Ability to build relationships to increase velocity of concept conversion to identifications
• Ability to work independently
• Avid knowledge sharer with the ability to mentor junior team members
• Acts as a resource for others with less experience
• Team player with the ability to collaborate across diverse and matrixed teams
• Ability to communicate the outcome of this research in a manner suitable for the intended audience
• Ability to work independently with less structured, more complex issues

*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.