Note: The job is a remote job and is open to candidates in USA. Optum is hiring a Payment Integrity Data Analyst to build and document targeted algorithms, analyze healthcare membership and cost data, and assure data quality. The role partners with stakeholders to develop analytics, reporting, and recommendations that support business needs and client agreements.
Responsibilities
- Research and identify areas for non-clinical medical cost improvements and alternative pricing strategies with government and commercial healthcare payers
- Interpret and analyze claims and membership data
- Write complex SQL queries to execute against large healthcare payer data sets
- Create and update automated database processes
- Analyze reporting utilized by internal customer groups
- Use logical, detail-oriented thought process to break down complex problems into individual sequential steps and identify root causes
- Identify and refine criteria to successfully increase efficiency of algorithm logic
- Contribute to 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
- Use business requirements for process automation, analytic development, strategic reporting, and system navigation
- Execute standalone production processes
- Triage anomalies observed with production processes
Skills
- 2+ years of experience in a corporate setting
- 2+ years of experience performing data analytics, including identifying trends in large data sets
- 2+ years of experience reading and writing complex SQL statements/queries
- 2+ years of experience with MS Excel, including pivot tables, formulas, calculations, charts, graphs, etc
- 2+ years of experience working from business requirements documents
- Experience in COB (Coordination of Benefits) auditing
- Experience in Medicare reimbursement methodology
- Knowledge of NAIC (National Association of Insurance Commissioners) guidelines
Benefits
- You can work remotely from anywhere within the U.S.; for hires in the Minneapolis or Washington, D.C. area, a minimum of four days per week in the office is required.
- A comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
Company Overview
Company H1B Sponsorship