Claims Quality Analyst Senior

Senior Claims Quality Analyst

Optum is a global organization that delivers care, aided by technology, to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Caring. Connecting. Growing together.

Are you ready to make a meaningful impact in a rapidly evolving healthcare landscape? At UnitedHealth Group, we're building a smarter, more precise approach to claims adjudication-and we're looking for a Senior Claims Quality Analyst to help lead the way. This fully remote role offers the flexibility to work from anywhere in the U.S. while contributing to high-impact quality assurance initiatives within behavioral health claims. You'll serve as a subject matter expert, leveraging your analytical skills and healthcare experience to solve complex problems, support internal teams, and drive continuous improvement in claims processing accuracy. If you're passionate about quality, thrive in a fast-paced environment, and want to grow your career with an industry leader, this is the opportunity for you.

The health care system is still evolving at a rapid pace. Technology is driving new advances in how patient care is delivered and how it's reimbursed. Now, UnitedHealth Group invites you to help us build a more accurate and precise approach to claims adjudication. In this role, you'll be responsible for all aspects of quality assurance within the claims job family. That includes assisting, educating, problem-solving and resolving challenging situations to the best possible outcomes. Join us and build your career with the industry leader.

This position is full-time (40 hours/week) Monday - Friday, employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm. It may be necessary, given the business need, to work occasional overtime. We offer 2 weeks of on-the-job training. The hours of training will be aligned with your schedule.

Primary Responsibilities:

• Analyze and investigate behavioral health claims
• Provide explanations and interpretations within area of expertise to internal operations teams
• Use pertinent data and facts to identify and solve a range of problems
• Investigate non-standard requests and problems for test scenarios
• Work exclusively within behavioral health claims
• Prioritize and organize work to meet deadlines
• Communicate claims testing results and insights to internal stakeholders

Required Qualifications:

• High School Diploma / GED OR equivalent work experience
• Must be 18 years of age or older
• 2+ years of experience processing behavioral health claims or working in claims quality
• 2+ years of experience in healthcare
• Intermediate proficiency in Microsoft Excel (data entry, sorting/filtering, pivot tables)
• Intermediate proficiency in Microsoft PowerPoint (creating and editing presentations)
• Flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 am - 5:00 pm.

Preferred Qualifications:

• Project coordination or management experience related to claims payment or healthcare initiatives
• Experience with process improvement methodologies
• Six Sigma certification (Green or Black Belt)
• 2+ years of experience analyzing and solving customer problems in an office setting
• 3+ years of experience using the FACETS claims platform

Telecommuting Requirements:

• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 - $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.