Note: The job is a remote job and is open to candidates in USA. UnitedHealthcare is simplifying the health care experience, creating healthier communities, and removing barriers to quality care. The Senior Data Scientist will support healthcare claims analytics, pricing accuracy, and operational performance initiatives by analyzing large-scale claims data, developing analytical models, validating claims processes, and delivering actionable insights. The role also collaborates with business, operations, product, and technology teams to improve claims adjudication, reporting, testing, and automation.
Responsibilities
- Analyze large-scale healthcare claims datasets to identify trends, patterns, anomalies, and opportunities for improving cost accuracy, benefit validation, and operational efficiency
- Conduct deep-dive analyses of claim performance metrics, including cost estimate accuracy, denial drivers, benefit validation outcomes, and claim adjudication results
- Translate complex analytical findings into clear, actionable recommendations that support business decision-making and operational improvements
- Develop analytical frameworks and performance measurement methodologies to evaluate claim outcomes and drive continuous process optimization
- Develop, enhance, and maintain data pipelines, datasets, and analytical models that support claims processing, pricing, and estimation workflows
- Partner with engineering and data teams to ensure data quality, consistency, and reliable integration across enterprise data sources and platforms
- Support the design and implementation of scalable analytical solutions that enable efficient reporting, monitoring, and decision support
- Leverage data from enterprise claims platforms, including CSP Facets and related adjudication systems, to validate business logic, investigate data discrepancies, and ensure alignment between estimated and actual claim outcomes
- Design and execute analytical testing strategies for trial claims, MBO validation runs, and large-scale claims testing initiatives
- Measure and compare performance across claim adjudication engines, identifying root causes of variance and recommending corrective actions
- Support defect identification, root cause analysis, and validation efforts throughout the claims lifecycle
- Collaborate with product, operations, business, and technology stakeholders to support strategic initiatives related to claim estimation, adjudication, pricing accuracy, and operational excellence
- Partner with subject matter experts to define requirements, validate methodologies, and ensure business objectives are accurately translated into analytical solutions
- Serve as a trusted advisor by providing data-driven insights and recommendations to support program planning and decision-making
- Build and maintain dashboards, reports, scorecards, and visualizations that communicate performance metrics and key insights to stakeholders and leadership
- Present findings and recommendations to both technical and non-technical audiences, ensuring clear understanding of business impacts and opportunities
- Monitor key performance indicators and proactively identify emerging trends or potential risks
- Identify opportunities to automate recurring analytical processes and improve operational efficiency
- Support continuous improvement initiatives through process optimization, advanced analytics, and data-driven recommendations
- Contribute to the development of scalable analytical tools, testing frameworks, and reusable reporting assets
Skills
- 5+ years of experience in healthcare analytics, claims analytics, data science, or a related analytical role
- Solid knowledge of healthcare claims processing, claim adjudication, pricing methodologies, and benefit structures
- Experience working with healthcare claims platforms such as Facets, CSP, or other enterprise claims adjudication systems
- Advanced SQL and data analysis skills, including experience with large datasets and cloud-based analytics platforms (Databricks, Snowflake, Azure, etc.)
- Proficiency in data visualization and reporting tools such as Power BI, Tableau, or similar platforms
- Experience presenting analytical findings to both technical teams and executive stakeholders
- Solid problem-solving, analytical thinking, and communication skills
Benefits
- Flexibility to work remotely from anywhere within the U.S.
- A comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution
- Development for other roles you may be interested in (subject to eligibility requirements where applicable)
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