Clinical Claims Analyst - Telecommute - Full-time / Part-time

Expanding access to affordable, high quality health care starts here. This is where some of the most innovative ideas in health care are created every day. This is where bold people with big ideas are writing the next chapter in health care. This is the place to do your life's best work.(sm)

This position performs analytics for the Oncology, Women's Health and Genetics lines of service and reports directly to the team's Director of Research. The charge of these lines of service is to improve the quality and efficiency of care for the respective population of members. The person in this role will support analytic efforts needed for projects at various stages including ideation, opportunity evaluation, operational development support, operational audits and savings analyses. Projects and programs are of various types including provider performance improvement strategies, medical cost containment programs, and special projects that directly impact operational and financial performance. Many of such programs have a foundation in evidence based medicine evaluation. In addition to analytics for specific project and programs, this person will support standard reporting to monitor trends on various outcomes for the lines of service.  Responsibilities for these lines of service span commercial, Medicare and community and state businesses. Many data sources are used in this role including Galaxy, UGAP, UHN Reporting, UDW, NHI/ORD as well as data specifically pulled from Medicare, Community and State and UHOne platforms.

Primary Responsibilities:

• Anticipate customer needs and proactively develop solutions to meet them


• Serve as a key resource for complex projects/programs


• Solve complex problems and develop innovative solutions


• Perform complex conceptual analyses


• Provide explanations and information to others on complex issues


• Understand and negotiate data limitations and caveats


• Motivate and inspire other team members


• Quickly assess issues and scenarios from a data and/or claims impact perspective and effectively educate and influence


• Perform data extractions, research data/claims issues


• Develop meaningful, accurate and succinct reports

Undergraduate degree

• 5+ years of experience working within a managed care organization, health insurer, or as a consultant in health related organization


• 5+ years of healthcare claim analysis experience


• Excellent verbal and written communication skills


• Excellent problem solving skills, including the ability to systematically analyze complex problems, draw relevant conclusions, and successfully devise/implement solutions calmly and effectively


• Ability to multi-task, shifting back and forth effectively among multiple activities


• Advanced level of proficiency in Microsoft Excel, Word and Access


• Strong ability to thrive and innovate in a dynamic environment

Preferred Qualifications:

• Understanding of basic statistics


• Understanding of reimbursement methods such as per diems, case rates, DRGs, fee schedules, ASP and AWP


• SAS programming experience


• Experience using SQL for data extraction


• Case mix strategies

Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 14 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can 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: Managed Care, healthcare, medical cost analysis, contract analysis, Medicare, network utilization, utilization rates, RBRVS, ASC groupers, APCs, per diems, case rates, DRGs, fee schedules, AWP, Minnetonka, Minnesota, MN