Manager Business Systems Analysis

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, and data 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 startCaring. Connecting. Growing together.

As a Manager of Business Systems Analysis on the Encounter Operations Team, you will own the analysis and translation of healthcare business, regulatory, and customer requirements into accurate, testable, and maintainable HIPAA transaction solutions. In this role, you will support behavioral health claims and encounters, with a focus on ASC X12 transaction content, implementation guides, companion guides, data maps, acknowledgments, remittance outputs, and production readiness.

You will lead cross-functional analysis initiatives, leverage approved digital tools to streamline analytical workflows, and partner with business and technical leaders to drive high-quality healthcare delivery solutions.

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

Primary Responsibilities:

• HIPAA Transaction Analysis & Compliance:Apply advanced knowledge of HIPAA transaction guides, data elements, situational rules, and usage requirements, with emphasis on 837 claim/encounter, 277CA acknowledgments, and 835 remittance transactions
• Requirements & Solution Definition:Interpret ASC X12 implementation guides, federally mandated companion-guide conventions, customer companion guides, and proprietary specifications to translate client needs into clear business, functional, mapping, and validation requirements
• Workflow Optimization & Continuous Improvement:Utilize enterprise-approved digital tools and automated capabilities to streamline analytical workflows, optimize data research, eliminate manual steps, and drive continuous quality improvement
• Data Mapping & SQL Validation:Develop, review, and maintain source-to-target data maps for SQL-based repositories; leverage SQL tools for data research, reconciliation, defect troubleshooting, and root-cause analysis
• Traceability & Compliance Audits:Maintain strict traceability across source requirements, business rules, data mappings, test scenarios, defects, and transaction outputs; conduct mapping and code audits prior to production release
• Stakeholder Collaboration & Agile Support:Serve as a subject matter resource and primary liaison among business, customer, and technology teams; support Agile delivery by refining user stories, answering development questions, and maintaining documentation alignment
• Production Support & Job Monitoring:Create, manage, and monitor scheduled mapping or transaction-generation jobs, investigating and resolving processing failures to ensure delivery timelines and operational quality
• Innovation & Industry Trends:Evaluate emerging industry trends, data standards, and technology solutions to inform solution design, continuous optimization, and strategic technology innovation

Leverage enterprise-approved AI tools to streamline workflows, automate tasks, and drive continuous improvement.

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

Required Qualifications:

• Bachelor's degree OR 4+ years of equivalent healthcare data and business systems analysis experience in lieu of a degree
• 4+ years of experience working with medical or behavioral health claims, encounters, transaction processing, or related healthcare data
• 4+ years of hands-on SQL experience for data research, reconciliation, transformation, and validation
• 2+ years of business systems analysis, systems analysis, or related functional analysis experience
• 2+ years of experience creating or reviewing ETL mappings and working with relational databases, claims systems, encounter systems, or data warehouses
• 2+ years of experience with enterprise data warehouses, ETL technologies (e.g., SSIS), or reporting tools (e.g., SSRS or Tableau)

Preferred Qualifications:

• Bachelor's degree in Information Technology, Finance,…