Claims Business Process Analyst

Job title: Claims Business Process Analyst

Company: UnitedHealth Group


Job description: Claims Business Process Analyst – Ireland – HybridOptum 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:As a Fortune 5 business, we’re one of the world’s leading healthcare companies. There are no limits here on the resources you’ll have or the challenges you’ll encounter.We have been supporting global healthcare systems from Ireland and the UK for more than 20 years, building a dynamic and diverse team of more than 2,100 talented individuals. With a continued record of growth and stability, we’re on the constant lookout for fresh talent to join our expanding teams.As a Claims Business Process Analyst, you will be responsible for performing complex reconciliations for members claim issues across 2-4 processing entities. This will require a financial and analytical mindset to be able to identify, remediate, and prevent issues affecting our members in delegated arrangements. The Claims Issue Resolution Analyst will be responsible for reducing the number of provider and delegate inquiries by working with entities to improve accuracy, decrease abrasion, and improve the overall experience of our customers and constituents.Working Schedule:This is a full-time position, Monday – Friday with standard working hoursCareers 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 offices and telecommuting from a home-based office in a hybrid work model.Primary Responsibilities of the Claims Business Process Analyst:

• Review and resolve complex provider and delegate complaint issues. Respond not only to the specific inquiry, but review case holistically for other potential issues

• Perform complex reconciliations overages across 2-4 processing entities

• Identify and articulate trends with our assigned delegates with the Sr. Issue Resolution Analyst and partner to work towards shift left initiatives

• Partner and collaborate internally to correct claims processing/cost share application errors and prevent recurring issues

• Identify and communicate opportunities for improving issue resolution processes, including automation

• Ability to work across lines of business, claims platforms and on service provider/Delegate issues as needed

• Perform reconciliation of member/provider inquiry cases, respond to the specific issue of the inquiry, as well as review for and resolve other issues that may be present for the member, outside of the inquiry

• Support and communicate with the Sr. Issue Resolution Analyst assigned to your Delegate/team. Perform root cause and trend analysis of issues by assigned Delegate. Clearly document findings and solutions to prevent future issues

• Communicate effectively (both written and verbal) with business partners

• Ownership of Resolving formal complaints and escalated items (CTM, DOIs, Member, etc.) in partnership with Sr. Issue Resolution Analyst, internal and external business partners to ensure that these items are being worked as priority and within the due dates

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 of the Claims Business Process Analyst:

• Undergraduate degree or equivalent healthcare experience
• Extensive (and recent) experience in claims processing using the NICE platform
• Proven knowledge and experience in claims research, analysis and reporting
• Experience with MS Office (Excel, Word)
• Demonstrate ability to handle non-standard processes

Preferred Qualifications of the Claims Business Process Analyst:

• Undergraduate degree or higher
• UNET claim experience
• COMET experience
• Adjustment highly preferred
• SharePoint development/creation

Soft Skills:

• Ability to problem solve and analyze issues and data
• Ability to communicate issues and recommend solutions effectively, both verbal and written
• Ability to prioritize and effectively handle multiple priorities
• Ability to communicate effectively with leaders / external parties, both verbal and written
• Excellent verbal and written communications

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.For more information on our Internal Job Posting Policy, click .All telecommuters will be required to adhere to the UnitedHealth Group’s Telecommuter Policy.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.Diversity creates a healthier atmosphere: Optum is an Equal Employment Opportunity employer, and all qualified applicants will receive consideration for employment without regard to gender, civil status, family status, sexual orientation, disability, religion, age, race, and membership of the Traveler community, or any other characteristic protected by law. Optum is a drug-free workplace. © 2024 Optum Services (Ireland) Limited. All rights reserved.#RPO

Expected salary:

Location: Dublin

Job date: Tue, 17 Jun 2025 22:49:54 GMT

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