Claims Business Process Analyst

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, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Primary Responsibilities:

• Create and execute standard, repeatable test protocols to ensure configuration & claims payment accuracy and the timely identification and resolution of defects
• Adhere to tight testing schedules tied to key project milestones
• Execute testing/UAT on complex projects with overlapping deadlines
• Maintain SOX-compliant documentation, including testing outcomes, defects, risks, change controls, issues, and decisions
• Execute and analyze system reports to verify the accuracy of system configuration & claims payment against business requirements and claim payment trends
• Identify and solve gaps and bugs to reduce potential for pended claims and payment errors
• Identify solutions and provide explanations and information to others on difficult issues
• Ensures that system configuration adheres to Medicare, Medicaid, and other federal/state regulations
• Manage workload to meet project deliverables and due dates
• Perform other duties as assigned
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

In this highly visible role, you will also have the opportunity to participate in building and establishing our policies, standards and procedures. Deadlines can be intense and having a keen attention to detail is critical to maintaining workflow and project timelines.

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

Required Qualifications:

• Any Degree / Graduation
• 1+ years of Facets experience
• 1+ years of Claims or Configuration experience
• 1+ years of Claims, Configuration or Testing/UAT experience
• Beginner level proficiency: Microsoft Office Suite
• Ability to work full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00am - 5:00pm CST or EST

Preferred Qualifications:

• Medicaid and/or Medicare experience
• SQL experience
• Experience working in a project-driven environment
• Proven effective verbal and written communication and presentation skills

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