[Hiring] Claims Business Process Analyst Senior @UnitedHealth Group

Role Description

This position is National Remote. You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges.

The C&S DSNP Maximum Out-of-Pocket (MOOP) Processor plays a critical role in protecting the member experience by proactively identifying, investigating, and resolving issues impacting Dual Eligible Special Needs Plan (DSNP) members' Maximum Out-of-Pocket accumulators.

This position is responsible for:

• Researching and resolving MOOP overages.
• Performing detailed root cause analysis.
• Identifying trends across claims, accumulators, eligibility, vendor, and system processes.
• Driving process improvements and reducing regulatory and financial risk.
• Ensuring DSNP members receive accurate benefits and cost-share protections.

Success in this role requires:

• Strong analytical skills.
• Claims adjustment expertise.
• Innovative problem-solving.
• Collaboration across internal and external business partners.

This position is full time (40 hours / week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime.

This will be on-the-job training and the hours of training will be during normal business hours.

Qualifications

• High School Diploma / GED OR equivalent work experience.
• Must be 18 years of age OR older.
• 1+ years claims adjustment experience within CSP Facets.
• Experience researching and resolving complex claims and accumulator issues.
• Ability to perform root cause analysis and identify trends.
• Experience working in healthcare operations, claims processing, OR government healthcare programs.
• Ability to manage multiple priorities in a fast-paced environment.
• Ability to work independently with minimal supervision.
• Ability to work full time (40 hours / week) Monday - Friday.

Requirements

• Experience supporting DSNP, Medicare, Medicaid, OR other government healthcare products.
• Knowledge of accumulators, member cost-share, and Maximum Out-of-Pocket (MOOP) processes.
• Experience partnering with IT teams on defect remediation and system enhancements.
• Understanding of healthcare regulatory requirements affecting member benefits and cost-share protections.
• Experience using data and reporting tools to identify trends and drive operational improvements.
• Experience with Microsoft Excel (sort, filter, formulas).
• Knowledge of SQL.

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.

Soft Skills

• Strong written and verbal communication skills.
• Strong analytical and critical thinking skills.

Benefits

• Comprehensive benefits package.
• Incentive and recognition programs.
• Equity stock purchase.
• 401k contribution (all benefits are subject to eligibility requirements).

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. The hourly pay for this role will range from $24 - $43 per hour based on full-time employment.

Application Deadline

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.