Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)
We'll put you in the driver's seat on vital projects that have strategic importance to our mission of helping people lead healthier lives. Yes, we share a mission that inspires. We need your organizational talents and business discipline to help fuel ours.
As the Claims Business Analyst you will provide support to the OptumRx team analyzing variety of related systems and Claims functionality. OptumRx is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.
Develop and implement effective business solutions through research, audit and analysis of data and/or business processes. Create, enhance, and maintain budget or financial planning models, surveys, benchmarks. Evaluate, interpret and analyze data and business process and analyze / monitor new, routine and ad hoc reports. Provide support when compiling and reporting information and assume responsibility for data integrity among various internal groups and/or between internal and external sources. Support short term operational activities. Run internal reports. Support gathering reports for audits. Research and resolve claim issues. Support new client processes.
Positions in this function conduct and manage outcomes of various studies that include analyzing, reviewing, forecasting, trending, and presenting information for operational and business planning. They support short and long term operational/strategic business activities - by developing, enhancing and maintaining operational information and models. They also develop and implement effective / strategic business solutions through research and analysis of data and business processes.
- Supports short and long term operational / strategic business activities through analysis
- Review and responsible for researching and providing issue resolution to complex issues / claim adjudication issues
- Create and run internal reports for audits
- Provide oversight and make recommendations to various data and reporting ensuring project completion is delivered
- Support new client processes and strategic projects
- Setup and maintain system set ups for Transaction Control Tables
- Process Claim Adjustments in system for reimbursement
- Managing claim reversal and processing windows
- Create, document, and maintain SOP (Standard Operating Procedure) and Policy and Procedure documents
- Review and analyze internal Standard Claims History layout
- Create and prepare reports / presentations for Management Team
- Maintain consistent and regular communication with IT and client by facilitating and attending meetings to review claims / service issues
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.
- HS Diploma / GED
- 2+ year claims data experience
- 2+ years of experience in Microsoft Excel or college completed courses / training in Excel
- 2+ years of experience in Microsoft Access or college completed courses / training in Access
- PBM or health industry experience
- Data analysis experience
- IBM AS400 / RxCLAIM
- Solid verbal and written communication, presentation, time / project management, problem-solving, organizational, and analytical skills
Careers with OptumRx. We're one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. Here you’ll fill far more than prescriptions. As a member of one of our pharmacy teams, you’re empowered to be your best and do whatever it takes to help each customer. You'll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There's no better place to help people live healthier lives while doing your life's best work.(sm)
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Job keywords: Claims Business Analyst, Claims Data, Irvine, CA, California