At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
The Claims Business Analyst operates with a high degree of independence to evaluate and interpret the needs and requirements of the claims operations function. This role is responsible for identifying effective solutions to complex and non-standard business challenges, ensuring alignment with operational goals and strategic initiatives.
Collaborate with business partners, technology teams, and operational leaders to facilitate discussions that clarify solution requirements and ensure mutual understanding.
Provide expert business guidance on complex process changes, acting as a liaison between business stakeholders and technical teams throughout the solution design and implementation lifecycle.
Support the deployment of system enhancements by contributing to the development of training materials and reference documentation to ensure smooth adoption and sustained operational performance.
Lead post-deployment activities, including the establishment and management of war rooms to address concerns, track defects, and drive timely resolution of issues.
This position is full-time (40 hours/week) Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of (7:00am – 5:00pm). It may be necessary, given the business need, to work occasional overtime.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Perform research to identify business requirements (e.g., interviews, observation, focus groups)
Obtain and validate business requirements from applicable stakeholders (e.g., using health plan documentation, provider manuals, national regulatory lists, etc.)
Analyze business requirements to determine if existing systems/processes are optimized to achieve those goals, and to identify potential problems/issues/ opportunities
Leverage forecasting systems/processes to identify applicable problems/issues/opportunities (e.g., inventory, inflow, overtime), and analyze historical data/trends to drive inventory inflow and resource planning
Identify root causes of identified claims processing problems/issues (e.g., root cause analysis, workflow analysis)
Identify/analyze current business processes and determine how well they meet business requirements
Leverage applicable industry standards/benchmarks, and identify opportunities for improvement based on industry standards
Utilize applicable service standards and other key performance metrics to drive identification of potential problems/issues/opportunities (e.g., performance guarantees, service level agreements, state contract requirements)
Develop/recommend solutions to identified claims business process problems/issues
Perform testing/piloting of potential changes to business processes, and ensure effectiveness prior to implementation
Provide ongoing communications/updates to applicable stakeholders on progress/ outcomes of process improvement efforts (e.g.,tollgates, leadership presentations, emails)
Provide training/education on claims business processes to applicable stakeholders (e.g., claims processors, systems staff, case installation staff, process documentation team, training staff)
Demonstrate knowledge of applicable claims processes (e.g., end-to-end claims cycle, auto-adjudication, manual work processes, payment methodologies, rework/adjustment processes)
Demonstrate awareness of the impact of claims business processes/changes on other parts of the business (e.g., state-specific configurations vs. global)
Demonstrate knowledge of applicable claims processing systems/platforms and data repositories (e.g., COSMOS, UNET, Facets, USP ORS, Macess)
Demonstrate knowledge of applicable legal/compliance requirements, and the penalties associated with non-compliance (e.g., HIPAA, CMS, state regulations, performance guarantees, service level agreements)
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 or equivalent work experience
Must be 18 years of age or older
1+ year Supervisory experience
3+ years medical claim experience
Experience with Microsoft Excel (pivot tables, basic analysis), Microsoft Word (create/edit documents), and Microsoft PowerPoint with ability to create all decks and analytics independently
Ability to work full-time (40 hours/week) Monday – Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of (7:00am – 5:00pm). It may be necessary, given the business need, to work occasional overtime.
Preferred Skills:
Experience in claims operations or a related field is preferred.
Success in cross-functional collaboration and stakeholder engagement.
Experience with Microsoft Access
Analytical/trouble shooting skills
Operational focus with demonstrated project, time, and change management
Ability to deliver within budget and timelines
Ability to travel 10%
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:
Demonstrate flexibility and the ability to deal well with ambiguity
Excellent communication, problem-solving skills
The ability to think strategically and anticipate future needs
Driver of change and constant process improvement
Ability to prioritize multiple responsibilities in a fast-paced environment
High level of emotional Intelligence
Proven ability to work independently and manage multiple priorities in a fast-paced environment.
Strong analytical, communication, and problem-solving skills.
Ability to coordinate in a matrixed team
Excellent process improvement skills
Professional demeanor in a challenging environment
*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 $58,800 – $105,000 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.
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