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Associate Business Process Analyst - Columbia, MD or Minnetonka, MN

UnitedHealth Group

Minnetonka, MN
Job Code:
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Job Details

Associate Business Process Analyst - Columbia, MD or Minnetonka, MN(Job Number:715171)

If you want to achieve more in your mission of health care, you have to be really smart about the business of health care. Challenge yourself, your peers and our industry by shaping what health care looks like and doing your life's best work.(sm)


Primary Responsibilities:

  • Understand the overall business model of Medicare Part D products, CMS guidance, and the PBM claim adjudication system and translate concepts into practice
  • Review sample files or claim records to determine appropriate benefit / claim administration is being delivered by the PBM
  • Perform claim / benefit issue identification, communication, root cause analysis, resolution and remediation activities related to claim review
  • Document / support issue tracking, trending, and reporting related to audit and quality review activities
  • Support individual and team goals of affordability, excellence, engagement, compliance and growth
  • Support short term quality and audit activities & research and analyze claim data to support review of audit samples, identify issue and root cause, review and QA audit material, audit universe analysis and QA
  • Support long term activities by influencing or providing input to forecasting and planning discussions; developing audit work plans
  • Work collaboratively with cross - functional and cross - organizational teams & build positive relationships, participate in calls and projects, prioritize tasks and projects to ensure timely completion and effective results
  • Able to work on more complex issues and projects
  • Work with minimal guidance
  • Be a resource for others, explaining complex issues, impacts and outcomes
  • Prioritize and organize own work to meet deadlines


Job Business Process & TQM
Primary Location US-MN-Minnetonka
Other Location US-MD-Columbia
Organization M&R Part D
Schedule Full-time
Number of Openings 2
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UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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