UnitedHealth Group is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm) Summary: Success as an Optum Medicaid Management Services (OMMS) Claims SME requires in-depth knowledge of the Claims-related components in the Medicaid Fee for Service / MMIS domain. Claims components include claims entry, adjudication, edits & audits, pricing, payment integrity, and payment. SMEs work in support of the Product team, and specifically the product owner, to establish clear requirements and designs that enable successful operations of an MMIS. SMEs are functional experts first and analysts second. They are hired specifically for their demonstrated expertise in specific functional areas from both a technology and operational standpoint. Stated otherwise, a SME not only understands the business, but can drive business decision making and innovation.You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities:Evaluates business requirements, prepares the detailed functional specifications, and prepares/reviews the technical specifications that follow project guidelines to deliver a SaaS based product that will enable the operational capabilities Conducts in-depth research related to business requirements and identifies how those requirements can be met and incorporated into the core OMMS/SaaS product Collaborates with business units (Operations/BPO) to understand BPaaS capabilities and the IT requirements for enabling such capabilities. Such collaboration requires deep knowledge in Claims Medicaid fee for service (MMIS) Collaborate with business units (Operations/BPO) and OMMS QA to identify acceptance criteria and potential test scenarios and ensure testing efforts align with delivered functionality Works closely with the OMMS Development/Engineering team in delivering a solution that meets the defined requirements Effectively communicates design details to all stakeholders and varying levels of the organization Maintains up-to-date knowledge of current trends in Government Information Technology solutions, issues in healthcare, CMS and MITA requirements, national and statewide standards and legislation, and changing policies and procedures Demonstrates proficiency with requirements management, Agile development, waterfall development, and other SDLC related tools
Required Qualifications:At least 7 years of MMIS experience with 4+ years of experience as a senior business analyst, system consultant, solution architect, developer, operations analyst, or SME in Claims-related components – entry, adjudication, edits and audits, pricing, payment integrity, and payment Experience working in an Agile delivery environment Demonstrated experience using strong communication skills to collaborate with business, client and technical resources Demonstrated ability to span geographic and time zone constraints to collaborate on solutions Committed to work in Optum's culture of high integrity, compassion, relationships, innovation and performance Willing to travel as needed, but typically not more than 25% per month on average Undergraduate degree or equivalent experience Preferred Qualifications: Healthcare industry experience Master's degree UHG experience Ability to work in Eden Prairie office 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*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.
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.