Health Care Economics Consultant - Eden Prairie, MN - 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 Health Care Economics Consultant 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 Consultant, 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)
 
This requisition is to fill a position in the Optum Performance Management team in support of our Fraud Analytics area. The Performance Management team was created to develop, standardize and implement the methodologies required to evaluate and improve the performance of Payment Integrity analytics. The team’s focus is the development of analytic metrics, the analysis of results and the identification of opportunities for false positive reduction in order to increase client savings and improve operational efficiency.
 
Primary focus area is the detection and prevention of fraud, waste and abuse for professional claims, through the rules-based analytics. These rules maximize claim payment accuracy, overpayment recovery, and education of our provider community. To ensure optimal performance and accuracy, existing rules are refined based on performance feedback and to adhere to regulatory compliance for updated code sets
 
Primary Responsibilities:


Gather and prepare analysis based on information from internal and external sources to evaluate and demonstrate program effectiveness and efficiency

Develop scalable reporting processes and querying data sources to conduct ad hoc analyses

Research complex functional issues using a variety of resources

Develop and prepare highly complex reports and provide and / or interpret information and data across divisions and departments

Assume responsibility for data integrity among various internal groups and/or between internal and external sources

Provide source system analysis
 

Required Qualifications:


Bachelor's degree or equivalent work experience

Demonstrable analytic experience working with fraudulent claims, fraud identification

3+ years of healthcare industry experience to include healthcare claims and member data knowledge

Experience with healthcare performance measurements

Intermediate level proficiency with SQL, SAS and / or other statistical programs

Intermediate level of proficiency working with MS Excel including formulas, calculations, charts, graphs, etc.
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: 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: Economics, Claims, Fraud, SQL, SAS, Eden Prairie, MN, Minnesota
 
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