Identify, analyze, and prevent Medicaid fraud, waste, and abuse by developing and deploying detection algorithms, writing advanced SQL, researching claims data, producing reports and visualizations, troubleshooting client issues, and mentoring analysts while collaborating with engineering and product teams.
Requisition Number: 2369918
Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.
The Fraud, Waste, and Abuse (FWA) Analyst plays a critical role in safeguarding state Medicaid programs by identifying, analyzing, and preventing fraudulent activities within Medicaid claims. You will be working with a State Government Product and Data Mining team. Your primary responsibility will be to assist in the development and deployment of algorithms designed to support program integrity across various platforms and states plus support our fraud and abuse detection product and services.
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 or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.
Primary Responsibilities:
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:
Preferred Qualifications:
*All employees working remotely will be required to adhere to UnitedHealth 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 to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.
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.
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.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.
The Fraud, Waste, and Abuse (FWA) Analyst plays a critical role in safeguarding state Medicaid programs by identifying, analyzing, and preventing fraudulent activities within Medicaid claims. You will be working with a State Government Product and Data Mining team. Your primary responsibility will be to assist in the development and deployment of algorithms designed to support program integrity across various platforms and states plus support our fraud and abuse detection product and services.
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 or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.
Primary Responsibilities:
- Write simple to complex SQL statements to extract data for client inquiry and research
- Utilize production reports to perform research and assess quality of overall data
- Analyze and interpret data to identify FWA trends and patterns within claims data
- Applies creative and analytical thinking to uncover and resolve complex fraud, waste, and abuse patterns
- Engage with clients to triage and manage incoming operational inquiries and tasks
- Identifies innovative approaches to resolve non-standard problems and deliver effective outcomes
- Interface professionally with data engineers, software engineers and other development teams
- Troubleshoot client operational issues quickly and comprehensively
- Support, train and mentor fellow analysts and developers
- Influences and provides input to improvement of operational processes
- Work is self-directed, less structured, more complex issues
- Function well within a matrix organization (E.g. - supporting multiple leaders)
- Proficient in research, interpreting, and analyzing diverse and complex data, and assessing data quality
- Proficiency with excel & visualization tools
- Intermediate to advanced computer skills consisting of Teams, Microsoft Excel, Outlook, Word, and Power Point
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:
- 5+ years of experience writing advanced SQL queries
- 5+ years of fraud, waste and abuse data mining experience
- 5+ years of intermediate to advanced proficiency in Microsoft Excel, Word, Teams, PowerPoint, and Outlook
- 4+ years of data analysis experience working with database structures
- 4+ years of healthcare claims experience
Preferred Qualifications:
- Industry certifications: Certified Professional Coder (CPC) or Certified Fraud Examiner (CFE)
- Experience with statistical analysis of data
- Experience with Rally
- Experience with data visualization tools and report interpretation
- Knowledge of Medicaid policy and real-life fraud, waste, abuse schemes
- Knowledge of healthcare claim adjudication systems
*All employees working remotely will be required to adhere to UnitedHealth 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 to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.
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.
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.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
Similar Jobs at Optum
Artificial Intelligence • Big Data • Healthtech • Information Technology • Machine Learning • Software • Analytics
The Account Executive manages relationships with State Government clients, focusing on client satisfaction, growth, and alignment of Optum's services with state needs.
Top Skills:
AnalyticsBpoHealthcare AccessProgram OperationsTechnology Solutions
Artificial Intelligence • Big Data • Healthtech • Information Technology • Machine Learning • Software • Analytics
As a Senior AI/ML Engineer, you will design and build end-to-end ML systems, manage ML lifecycle workflows, and ensure compliance with AI standards within the healthcare sector.
Top Skills:
AirflowAWSAzureAzure MlCi/CdDagsterDockerGCPGrafanaKafkaKinesisKubeflowKubernetesMlflowOpentelemetryPrefectPrometheusPythonPyTorchRaySagemakerScikit-LearnSparkTensorFlowTerraform
Artificial Intelligence • Big Data • Healthtech • Information Technology • Machine Learning • Software • Analytics
Lead governance and lifecycle management of enterprise Splunk knowledge objects, enforce CIM normalization and taxonomy, build automations for data quality, author standards and documentation, train teams, and act as SME across detection, SOC, and platform engineering to ensure high-fidelity SIEM detections at scale.
Top Skills:
AcsAnsibleAWSAzureBashCi/CdEdge/Ingest ProcessorGCPGitGithub ActionsKafkaKv StoreLinuxPythonSpl (Search Processing Language)Splunk Apps & Add-OnsSplunk EnterpriseSplunk Enterprise Security (Es)Splunk UbaSummary IndexingTerraformTsidxTstatsWindows
What you need to know about the Belfast Tech Scene
If asked to name the birthplace of the RMS Titanic, you might not say Belfast. Similarly, if asked to name Europe's leading destination for foreign direct investment in new software development, Belfast might not come to mind. Yet, both are true. The city has emerged as a tech powerhouse, recently ranked among the best in the U.K. for tech careers — especially for software developers. It also leads the U.K. with the highest percentage of software development jobs advertised.
