Healthcare Economics Consultant - 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 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) 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

Logical, detail oriented thought process with the ability to breakdown a complex problem into individual root causes

Ability to identify payment errors regardless of claim system by reviewing data and possessing claims coding experience

Ability to identify and refine criteria to successfully increase efficiency of algorithm logic

Ability to serve the team in a Lead position in the absence of Manager

Provide claims, premium, capitation and membership data in support of underwriting, Actuarial and utilization analysis

Complete business analysis on new analytic opportunities that may include proof of concept, functional testing, determination of yield, time to complete, and financial impact

Explore potential trends identified by matrix business partners

Generate functional business requirements used for automation of processes, analytic development, strategic reporting, and system navigation

Develop training documentation diagramming manual processes

Execution of standalone production processes

Triage anomalies observed with production processes

Research, identify, and document potential areas for medical cost improvements and alternative pricing strategies with government and commercial payers

Required Qualifications:

Bachelor's degree or equivalent work experience
3+ years of work experience in a corporate setting
1+ years of health care experience working with claims data and medical codes
Intermediate in performing data analytics
NAIC Guidelines knowledge
2 + years of experience in Medicare reimbursement methodology
2+ years of Coordination of Benefits auditing experience
At least a beginner level proficiency with SQL and / or other statistical programs
At least an 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: healthcare economics, consultant, claims, medical codes, analytics, Franklin, TN, Tennessee