Data Mining Ideation Consultant - National Remote

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

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 diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

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. UnitedHealth Group is a team of more than 260,000 people who are building career success through commitment, compassion and a desire to make a difference. Join us. Learn more about how you can start doing your life's best work.SM

As part of our Recovery and Resolutions team, you'll provide consultative support to our business units and external vendor organizations. You'll handle requests, define business requirements and coordinate resolutions incorporating State/Federal regulations. Join us and build your career with an industry leader. This is a challenging role with serious impact. You'll be assisting, educating, problem-solving and resolving challenging situations to the best possible outcomes. You'll need to understand and interpret clients' needs and ensure service and delivery excellence supporting the Fraud, Waste, Abuse, and Error product suite. This involves working with a high complexity solution set and cross functional teams to proactively review, research and resolve highly escalated inquiries.

This position is full-time. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am – 5:00pm. It may be necessary, given the business need, to work occasional overtime.

We offer 4 weeks of paid training. The hours of training will be based on your schedule or will be discussed on your first day of employment.

• All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.

Primary Responsibilities:

• Become an expert in assigned clients payment systems and policies
• Identify issues with client overpayments through the advanced analysis of client data
• Present overpayments to client through documentation and concept presentations
• Document all new concepts and train internal analysts on identification and correct payment calculations
• Maintain existing productions queries and enhance or correct as necessary
• Achieve annual trend approval rate goals
• Serves as a resource to others on issues pertaining to client policies and overpayment concepts

You’ll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School Diploma / GED
• 2+ years of experience reviewing claims data with contractual reimbursement and payment policy review, to identify incorrect reimbursement
• 2+ years of experience analyzing data to identify new overpayment and/or cost-saving opportunities
• 2+ years of experience working as a claims auditor, independently without direct supervision
• Advanced Microsoft Excel experience (formula creation, Pivot Tables/VLOOKUP) OR experience working with SQL (basic scripting experience)
• Experience performing independent research to work toward creative solutions
• Proficiency in Microsoft Office including Microsoft Outlook and Microsoft Word
• Experience recalculating expected claim reimbursement
• Ability to identify and present trends in large datasets
• Must be 18 years of age OR older
• Ability to work from 8:00am - 5:00pm including the flexibility to work occasional overtime as the business need

Preferred Qualifications:

• Medical coding knowledge or experience
• Experience identifying payment errors by reviewing data
• Experience reviewing claim data with COB (Coordination Of Benefits)

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

California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington or Rhode Island Residents Only: The annual range for California / Colorado / Connecticut / Hawaii / Nevada / New York / New Jersey / Washington / Rhode Island residents is $70,200 - $137,800 per year. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

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.

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.

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