Claims Business Analyst

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Claims Business Analyst (2392919)

Claims Business Analyst - 2392919

At United Healthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us to start
Caring. Connecting. Growing together.

As a Claims Business Analyst with us, you will monitor patterns of potential fraud, waste and/or abuse to ensure compliance and be closely involved in the investigation process. It will be a whirlwind, but it will also be the place where you can help make the health system work better with the support and resources of a Fortune 6 leader. If you call yourself a data guru, then you’ll be perfect for this role.

As you respond to inquiries, requests and actions, you’ll need to be able to communicate research and data findings in a meaningful way.

You’ll enjoy the flexibility to work remotely
* from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis, MN;
Washington, D.C.;
Cypress, CA;
Atlanta, GA;
Metairie, LA;
Columbia, MD;
Richardson, TX;
Draper, UT; and Wausau, WI areas, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities:

• Perform data analysis and generation activities for the fraud investigations team including data extracts, summaries, random sampling, and special projects
• Prepare pharmacy and medical claims data for investigative business needs and work with investigations teams to better understand the content of the data sets
• Establish and implement standard policies, procedures, processes and best practices across the company to promote compliance with applicable laws and contractual obligations
• Support the collection of data for SIU (Special Investigations Unit) activities and generate routine regulatory and executive level reports for distribution
• Produce, publish and distribute scheduled and ad-hoc client and operational reports relating to the development and performance of products, processes and technologies
• Analyze and interpret data to identify trends, patterns and opportunities for the business and clients
• Communicate complex information via phone conversations and emails to non-technical clients, external customers, internal customers and executives

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
• Minimum of 2+ years of experience as a data analyst supporting pharmacy and/or medical claims environment or projects, etc.
• Advanced level of proficiency with MS Excel (advanced formulas, pivot tables, macros, lists, statistical functions, etc.)
• Intermediate level of proficiency with MS Office (Word, PowerPoint and Outlook)

Preferred Qualifications:

• Experience working in a government, legal, health care, managed care and/or health insurance environment in a regulatory, privacy or compliance role
• Experience working independently and researching regulations
• Experience with VBA (visual basic for application) experience
• Experience with Snowflake, SAS, Python, or SQL
• Industry Certification (CFE, AHFI, CPC)

* All Telecommuters will be required to adhere to United Health 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…