Medical Claims Rule Developer - Telecommute

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do your life's best work.(sm)

You are a thought leader who thrives on developing new solutions to solve tough challenges. As a critical member of our rule development team, you will help rewrite the future of Optum. Here, your analytical and innovative skills will help us with our mission of helping people live healthier lives. Yes, we share a mission that inspires. And we need your organizational talents and development acumen discipline to help fuel that mission. You will be a primary contributor in developing, testing, and deploying key claims processing solutions to support business initiatives, while working with cutting edge technology. The successful candidate will have strong communications skills and the ability to liaison between technical and non-technical personnel. The ability to adeptly navigate ever changing priorities is also a key skill of the Rule Developer. As a Rule Developer, you will be empowered to support short and long term operational/strategic claims solutioning activities; develop, enhance, and maintain rule development and KB's (Knowledge Base) that will have an impact on business decisions. In this role, you will have the opportunity to use your keen analytical and data management skills to create valuable solutions to improve the health care system. Join us!

You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:
Software engineering is the application of engineering to the design, development, implementation, testing and maintenance of software in a systematic method. The roles in this function will cover all primary development activity across all technology functions that ensure we deliver code with high quality for our applications, products and services and to understand customer needs. This role includes, but are not limited to analysis, design, coding, engineering, testing, debugging, standards, methods, tools analysis, documentation, research and development, maintenance, new development, operations and delivery. With every role in the company, each position has a requirement for building quality into every output. This also includes evaluating new tools, new techniques, strategies; Automation of common tasks; build of common utilities to drive organizational efficiency with a passion around technology and solutions and influence of thought and leadership on future capabilities and opportunities to apply technology in new and innovative ways.

• Build and implement simple to complex claim editing logic in support of internal payment policies
• Act as a thought leader/ SME in the design and implementation of claim editing logic by:
  • Being able to identify gaps in logic or business requests
  • Being able to work and speak with authority on current claim editing logic
  • Being able to develop architecturally sound editing rules for complex business requests
• Participate in project teams with both internal and external customer(s) to assure high quality through mgmt of ongoing processes
• Understand and manage business requirements in an effort to minimize scope issues
• Demonstrate the ability to work independently and manage competing priorities
• Demonstrate excellent conflict resolution and negotiation skills
• Assist in troubleshooting of technical issues as identified
• Review and contribute to overall QC/QA of test plans, and assure appropriate unit testing coverage
• Work collaboratively with all key team members
• Analyzes and investigates
• Provides explanations and interpretations within area of expertise

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:

• 3+ years of experience in claims processing
• 3+ years of experience with healthcare industry
• 3+ years of experience in reimbursement policy
• 3+ years of experience in claim edit development
• 2+ years of experience in Medicaid claims processing
• 1+ years of experience in user acceptance testing
• Experience using Rally

Preferred Qualifications:

• Bachelor's degree
• Experience in MS Teams
• Experience in MS SharePoint
• Experience with ALM (Appl Lifecycle Mgmt)
• Experience with automated testing tools, such as TCM (Test Case Mgr)
• Knowledge of iCES or CES
• Customer service focused
• Proficiency with MS Office (including Word & Excel)
• Excellent oral and written communication skills, with exceptional attention to detail and highly logical thinking
• Ability to generate innovative ideas to resolve problems, with solid analytic, technical and problem-solving skills

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment

Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)

Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $66,100 to $118,300. The salary range for Connecticut / Nevada residents is $72,800 to $129,900. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.

*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity/Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.