Senior Health Care Analytics Analyst - Franklin, TN - Full-time / Part-time

Some people take things as they come. Others relentlessly push themselves to go farther. Combine health care and technology, which are two of the fastest-growing fields on the planet, with UnitedHealth Group's culture of performance, collaboration and opportunity and this is what you get: industry-leading health care services at a company that's improving the lives of millions. As the Senior Health Care Analytics Analyst you will design and develop reports and analyze data to measure clinical outcomes, network performance and methodology levers. You will investigate key business problems through quantitative analyses of utilization and health care costs data. As the Analyst, you will interpret and analyze clinical data from various sources and recommend best approaches for its consolidation. Your analyses will be used to create viable, real-world solutions in a complex health care landscape. The work is as challenging as it is rewarding. You'll open doors to new opportunities. This is where bold people with big ideas are writing 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:

• Interpret and analyze claims, premium, capitation and membership data in support of Underwriting, Actuarial and utilization analyses


• Lead projects to completion by contributing to database creation, statistical modeling and financial reports


• Create and update automated processes within client databases


• Analyze reporting tools utilized by the internal customer groups


• Identify patterns of claim payment abnormalities that will lead to new rule development through data analysis


• Research new leads for viability


• Populate client's test file templates and gather all supporting documentation for trend approval


• Develop metrics to provide forecasting on new rule profitability and FTE needs


• Write Policy and Procedure documents for each new rule and maintenance existing documents as the rule logic changes


• Research production rule revisions for accuracy while working directly with the Data Analyst to test and implement changes


• Facilitate new rule kick off calls with Operations, Centers of Excellence, and the recovery team


• Assist on client calls with the presentation of new rules for client approval


• Monthly analysis of rule performance; forecasted vs. actuals


• Maintenance of existing rules to drive maximum rule performance on output and efficiencies


• Weekly management reports outlining work completed and issues encountered


• Screen scrape and automation ideation as well as providing Data Analyst support for existing automations and scrapes

Required Qualifications:

• 1+ years of Medicaid experience


• 2+ years of healthcare claims processing and/or auditing experience


• Intermediate level of proficiency working with MS Excel including formulas, calculations, charts, graphs, etc.


• Excellent written and communication skills


• Proficiency in performing data analysis, breaking down complex problems into individual root causes


• Bachelor's degree or equivalent work experience

Preferred Qualification:

• Medicare rules and regulations


• Team lead experience


• Experience training peers and/or other departments

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: mid-level health care economics job, math, data analysis, reporting, quantitative analysis, health care, SQL, SAS, analytics, claims, programming, economics, Franklin, Tennessee, TN