End to End Encounter Operations Business 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 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 start Caring. Connecting. Growing together.

About the Role:

This position will support improving end to end Capitated Delegated encounter accuracy, timeliness, and completeness. The role identifies issues and leads them to resolution. You will provide technical support for outstanding issues identified and proactively seek out issues not identified. Scope includes leading meetings and strengthening relationships with external delegates to improve the End-to-End encounter submission process and providing technical knowledge sharing and consulting. This position requires a critical thinker with the ability to act independently to lead and diagnose process improvement opportunities, as well as the ability to drive complex issues to resolution with minimal supervision and communicate clearly to multiple stakeholders.

Working Schedule:

This is a full-time position with standard working hours of Monday to Thursday from 8:30am to 17:30pm and Friday from 8:30am to 13:30pm Irish Standard Time. Occasional after-work hours may be required to support operational needs.

Careers with Optum offer flexible work arrangements and individuals who live and work in the Republic of Ireland will have the opportunity to split their monthly work hours between our Letterkenny office and telecommuting from a home-based office in a hybrid work model.

Primary Responsibilities:

Analyses detail delegate encounter reports and identify issues timely to appropriate business partners for remediation of issues and escalate as needed

Performs ongoing monitoring to ensure encounters are received timely, accurately, and completely

Uses technical skills to lead individual issue remediation efforts with the delegate

Leads deep dive calls with delegate partners, focusing on ways to improve their encounter submission processes

Supports projects to resolve escalated encounter edit submission issues

Researches and explains variances relative to encounter submissions, including but not limited to, all relevant member cost share, encounter volumes, rejections, etc.

Identify automation solutions to improve encounter analysis efficiency and accuracy

Shares pertinent knowledge with team members. Is open to feedback from other colleagues. Serves as a resource to others

Effective communication (written and verbal) of the issues, including any barriers or risks to their resolution. Clearly and concisely articulates the issues on deep dive calls. Summarizes issues clearly and concisely on the team SharePoint

Independently monitors and closes issues with minimal supervisor intervention. Clearly documents reasons for non-closure

Uses critical thinking skills to assess and interpret delegate needs and requirements

Tracks issues to closure in a timely manner

Works with minimal guidance; seeks guidance on only the most complex tasks

Uses good judgment to challenge our current processes/procedures and submit recommendations to develop more efficient solutions for the team and higher quality for providers

Learn and effectively use multiple platforms and systems

Adaptable and capable of working in a fast-paced environment

You will 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 providing development for other roles you may be interested in.

Required Qualifications:

Bachelor's degree from an accredited college or university, or equivalent professional experience

Proven experience or demonstrated knowledge of medical claims processes and/or the healthcare industry

Proven experience in issue resolution

Proven experience in business analysis, including presenting data, insights, and recommendations to management

Demonstrated solid written and verbal communication skills

Proven ability to collaborate with stakeholders to assess potential issues and leverage operational metrics, data, and analytics to drive business performance

Proven ability to develop and implement business process improvement initiatives, including process documentation

Demonstrated high proficiency facilitating meetings and leading business discussions with stakeholders

Proven ability to research, analyze, and resolve conflicting or inaccurate data

Demonstrated high proficiency in Microsoft Office applications

Preferred Qualifications:

Demonstrated knowledge of Value-Based Contracting or capitated delegated division of responsibility business models

Please note you must currently be eligible to work and remain indefinitely without any restrictions in the country to which you are making an application. Proof will be required to support your application.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

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