Optum, a trailblazer in global healthcare, is dedicated to enhancing health outcomes through innovative technology that empowers millions to lead healthier lives. By joining our team, your contributions will play a vital role in connecting individuals with essential healthcare resources, pharmacy benefits, and data to promote their well-being. Experience a workplace culture that emphasizes diversity, inclusion, and collaboration among talented professionals, coupled with a comprehensive benefits package and ample opportunities for career advancement. Step into a role where your efforts will make a real impact on the communities we serve while championing global health equity. Come, let’s embark on a journey of Caring. Connecting. Growing together.

In this pivotal role, you will engage in thorough research and analysis to tackle significant business challenges, utilizing quantitative assessments of utilization and healthcare costs data. Your findings will guide management decisions, identify opportunities for medical cost reductions, and propose innovative pricing strategies. The insights you provide will be essential for actuarial, financial, and utilization analyses.

Enjoy the freedom to work remotely from anywhere in the U.S. as you take on these exciting responsibilities.

Your Key Responsibilities:

• Generate and refine a dynamic portfolio focused on cost-saving initiatives that deliver quantifiable outcomes for assigned clients, while ensuring timely and meaningful updates.
• Engage in analytical, experimental, and investigative processes to support innovative concept development.
• Build and maintain strong collaborative relationships with internal stakeholders to define, align, and implement payment integrity initiatives for assigned clients.
• Encourage senior leadership to embrace new ideas, strategies, and products.
• Advise on enhancements to existing product development processes, informed by market research and emerging trends.
• Serve as an industry thought leader and expert on medical claims, associated trends, pricing, and cost management initiatives.
• Guide concepts and projects from inception through to successful completion.

You will be recognized and rewarded for your contributions within a challenging environment that provides clarity on success and development opportunities for future roles.

What You Bring:

• 4+ years of experience in auditing, billing, and/or coding claims with a focus on the Molecular/Genetic area.
• 4+ years in the healthcare industry, including Medicare, Medicaid, or Commercial sectors, with a strong background in Payment Integrity or Revenue Integrity.
• 3+ years of experience in collaborative and consultative roles, establishing quick credibility with diverse management levels across multiple functions.
• 2+ years of experience researching and analyzing claims data to identify trends and patterns.
• 2+ years presenting proposals to stakeholders and internal clients.
• Experience in Project Management.
• Strong knowledge of CMS regulations, billing codes, and related services.

Preferred Qualifications:

• Undergraduate degree.
• Advanced degree in healthcare or medical fields.
• Coding certification from AAPC or AHIMA.
• 3+ years in claims adjudication or revenue cycle management.
• 2+ years experience in a matrixed, fast-paced environment with strict deadlines.
• Background in a Laboratory or Genetics setting.
• Proficiency in SQL, SAS, or other statistical analysis tools.
• Excellent computer skills including Excel (Pivot Tables, Advanced Formulas, Macros), Visio, PowerPoint, and Tableau.
• Strong project management capabilities with exceptional critical thinking and problem-solving skills.
• A self-driven professional able to handle multiple projects and meet tight deadlines.
• Outstanding presentation, communication, and negotiation skills.

All remote employees must adhere to UnitedHealth Group’s Telecommuter Policy.

The salary range for this position is $106,800 to $194,200 annually, determined by various factors including local labor markets, education, work experience, and certifications. UnitedHealth Group complies with applicable minimum wage laws. Alongside your base salary, we offer an extensive benefits package, including incentive programs, stock purchase options, and a 401(k) contribution—all subject to eligibility requirements.

Application Deadline:
This position will be open for a minimum of 2 business days or until we receive a sufficient number of applicants, with the possibility of early closure based on the volume of applications.

At UnitedHealth Group, our mission is to enhance the health of individuals and improve the healthcare system for all. We believe everyone, regardless of race, gender, sexuality, age, location, or income, should have the opportunity to attain their healthiest self. We are committed to reducing barriers to health, especially for people of color, marginalized communities, and those with lower incomes. Our goal is to provide equitable healthcare that addresses disparities and optimizes health outcomes, reflecting our core mission.

UnitedHealth Group is an Equal Employment Opportunity employer and qualified applicants will receive consideration without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, as well as any other characteristic protected by applicable laws.

UnitedHealth Group maintains a drug-free workplace and candidates must pass a drug test prior to employment.