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.
Work area includes development of clinical deterministic/probabilistic rules to identify aberrant billing/Fraudulent patterns in healthcare institutional claims data for UHC all Line of businesses.
Role requires development and evaluation of various clinical deterministic & probabilistic rules, data-maps through domain expertise and advanced data mining techniques, identify improvement opportunities resulting in business impact, creating different metrics for clinical rules and innovation or optimization algorithms and building solid relationships with global analytics teams.
Role also requires significant amount of team and stakeholder management, project delivery, Quality assurance skills in areas like, clinical rule development, validation and data maps development, Rules maintenance, validation and enhancements, exploratory data, and multivariate analysis, improving true positive rate of existing analytics
Shift: A2 (11:00 AM to 8:30 PM IST)
Grade: 27 (Senior Data Analyst)
Location: Noida
Primary Responsibilities:
- Communicating key analytic findings to client and responsible for addressing client's analytic concerns
- Communicate clearly and effectively both orally and in writing; conduct meetings and make professional presentations
- Organize and manage time and resources; establish priorities and coordinate work on many projects simultaneously
- Research potential overpayment scenarios through secondary research, seeking to identify overpaid claims used to build recurring algorithms
- Identify and refine criteria to successfully build and enhance new and existing algorithm logic, ensuring correct claim payment
- Research and quickly identify patterns of claim payment abnormalities through big data analysis
- Providing both clinical and technical consulting to business leaders at an appropriate level of information encapsulation
- Develop metrics to forecast new algorithm profitability
- Work to gather, examine, and analyze data; write technical specifications for manipulating data to look for Fraudulent patterns
- Demonstrate a solid understanding of project scope, data extraction methodology, design of dependent and profile variables, logic and design of data cleaning, exploratory data analysis
- Identify opportunities, pose business questions, and make valuable discoveries to prototype development and rule improvement. Actively consult with business stakeholders and subject matter experts to ensure appropriate medical and business content is incorporated into analytic approaches
- Be able to work closely with Business Analysts, Domain SMEs to understand business needs and help define requirements for reporting solutions Ability to work closely with onshore and offshore business analysts, Domain SMEs and leads to understand business needs and help define requirements for reporting solutions
- Ensures team gathers right requirements from the business stakeholders and involve in, BI/BRD design and ensure that all specifications are complete, consistent, concise, and achievable
- Deliver robust and scalable analytic solutions in an automation ready state for payers and provider markets
- Self-drive knowledge accumulation of methods and modeling advances by reading research publications, blogs and attending presentations and webinars
- Comply with all applicable Company policies, procedures, and business directives, changes including those relating to work location, team assignments, work schedules, and flexible work arrangements
Required Qualifications:
- Bachelor's or higher degree in related Information Technology field/Healthcare/clinical research
- Medical coding/clinical certification like CIC/COC or any other medical coding certification/knowledge
- 7+ years of experience in conducting research-minded clinical data analysis on variety of healthcare data types/forms with aim to utilize this analysis into building or optimizing clinical solutions; 4+ years of experience in data analytics and claims processes
- Experience in research and finding data anomalies, and analysis method with healthcare claims and breaking down and clearly define problems, performing root cause analysis to identify key factors and reasons prompting those factors
- Scrum or other Agile development experience
- Data analysis experience
- Knowledge of analytical tools and techniques required to perform data analysis. Should have ability to handle/work on medium/large data sets
- In-depth understanding of US healthcare, Payment integrity processes, Claim lifecycle, Adjudication & Pre-Adjudication process
- Proficiency in tools such as Microsoft Office Excel/Access/PowerPoint; Working Knowledge of basic SQL or SAS is required
- Demonstrated solid project management skills, ability to influence cross-functionally in a rapidly evolving business environment while managing multiple / concurrent projects
- Demonstrated ability to communicate ideas effectively and concisely to all levels of Management, business partners, and to other external clients and ability to work independently
- Demonstrated solid analytical, complex thinking, problem solving, and troubleshooting abilities
- Proven excellent written and verbal communication skills
- Proven excellent organizational skills and attention to detail
Preferred Qualifications:
- Scrum or other Agile development experience
- Data analysis experience
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.