Associate Director, Health Care Economics - Multiple Locations - Full-time / Part-time

As the rules continue to change, one company continues to lead. No industry is moving faster than health care, and no organization is better positioned to lead health care forward than UnitedHealth Group. We invite you to bring your expert knowledge and innovative ideas to an elite team within a culture built for collaboration. At UnitedHealth Group, we seek people like you who have the ability to drive change, take appropriate risks and influence individuals at all levels of the organization. As the Associate Director of Health Care Economics, you will design advanced analytical strategies that enhance fraud detection capabilities and recovery efforts for our business partners.  This is your opportunity to help write the next chapter in health care. Join us. There's never been a better time to do your life's best work.(sm)

Primary Responsibilities:

• Manage and develop your elite team of Medical Coder Analysts and Modelers to interpret and analyze data and recommend best approaches


• Design advanced analytical strategies through effective creation and deployment of rules and models in the detection / deferment of fraud waste and abuse


• Data analytic responsibilities include sample design, data prep, identification of appropriate analytic and statistical methodology, model development and documentation of process results for models and rules


• Partner effectively with business leaders and finance to demonstrate the effectiveness and impact of the analytical tools developed to support efforts to win new business


• Oversee process to implement pre and post pay rules and models in the hardware/software supported by the business unit


• Oversee Professional and Facility analytic delivery for Fraud Analytics, including vetting ideas referred to Fraud Analytic delivery team using knowledge and experience with clinical practice, medical billing and coding, policy coverage, regulations, and guidelines, and healthcare fraud detection to question methodology and approaches and make suggestions for the most efficient and effective way to build fraud detection and prevention rules and models for optimal success


• Train business partners on how to most effectively incorporate rules and model results into their work flow process


• Lead analytic deployment and communication for internal partners, including understanding client needs, business requirements, and their data environment to tailor analytic deployment to the unique needs of their business and to maximize their ROI and minimize their fraud risk exposure


• Make sound, data-driven decisions regarding continued analytic development activities based on results of test data and propose changes to queries and logic to ensure accurate and efficient identification of potential fraud, waste, and abuse


• Balance staff workload assignments to meet timeliness goals for Fraud Analytic delivery team; reprioritize workload, as needed, to support team goals


• Bring these capabilities to OptumInsight customers across markets: intersegment, government and commercial

Required Qualifications:

• Bachelor's degree


• 1+ years of experience in the development of models


• 2+ years of management experience


• Experience with health care claims data


• Knowledge of advanced statistical methods used in the evaluation of healthcare claims data (Clustering, social network analysis, parametric, non-parametric, neural networks, etc.)


• Minimum of an advanced level of proficiency working with MS Excel including advanced formulas, pivot tables, macros, lists, statistical functions, etc.


• Project management experience


• Experience developing analytical concepts and clearly understand how analytical solutions can help customers reduce their healthcare claim costs


• Experience developing models and rules and documenting process results


• Exceptional ability to drive results through strong collaborating and influencing skills across all business segments and geographies

Preferred Qualifications:

• Bachelor's degree in mathematics, Finance, statistics or related field


• Master's Degree or PhD


• 1+ years of experience in the development of fraud waste and abuse detection models


• Hands-on modeling skills and strong analytic rule and modeling experience using SAS

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make the health system work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Diversity creates a healthier atmosphere: 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: senior level health care economics job, math, data analysis, reporting, quantitative analysis, health care, SQL, SAS, analytics, claims, manager, management, leadership, Franklin, Tennessee, TN, Eden Prairie, Minnesota, MN, Wauwatosa, Wisconsin, WI