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Senior Healthcare Economics Analyst - Franklin, TN or Wauwatosa, WI

UnitedHealth Group

Wauwatosa, WI
Job Code:
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Senior Healthcare Economics Analyst - Franklin, TN or Wauwatosa, WI(Job Number:731800)

Some people take things as they come. Others relentlessly push themselves to go farther. Combine health care and technology, which are two of the fastest-growing fields on the planet, with UnitedHealth Group's culture of performance, collaboration and opportunity and this is what you get: industry-leading health care services at a company that's improving the lives of millions. 


As a Senior Healthcare Economics Analyst within our Advanced Analytics Lab within OptumInsight, you will work with the IT team to develop, test and implement core extracts as they relate to the identification and evaluation of overpayments with the goal to achieve and exceed monthly audit targets. You will develop, collect and analyze metrics and data to formulate fact - based decisions and proactively implement process improvements through the prospective and  /  or retrospective analysis of claim data.


Broadly, as the Senior Healthcare Economic Analyst you will research and investigate key business problems through quantitative analyses of utilization and healthcare costs data and provide management with statistical findings and conclusions. You will identify potential areas for medical cost improvements and alternative pricing strategies. The work is as challenging as it is rewarding. You'll open doors to new opportunities. This is where bold people with big ideas are writing the next chapter in health care. Join us. There's never been a better time to do your life's best work.(sm)


Primary Responsibilities:

  • Research potential overpayment scenarios through the use of client policies and provider contracts, seeking to identify overpaid claims used to build recurring algorithms
  • Identify and refine criteria to successfully build and enhance new and existing algorithm logic ensuring correct claim payment
  • Research and quickly Identify patterns of claim payment abnormalities through big data analysis
  • Develop metrics to forecast new algorithm profitability
  • Write business requirement documents for new algorithms and update existing documents as the algorithm logic is developed or changes over time
  • Maintenance existing production algorithms to maximize performance while working directly with the programmers to test and implement changes
  • Facilitate new algorithm kick off calls and training with our matrix partners
  • Monthly analysis of algorithm performance; forecasted vs. actuals
  • Provide management weekly reports outlining work completed and issues encountered
  • Lead special projects with little to no manager supervision or assistance
  • Breakdown complex problems into individual root causes


Job Healthcare Econ & Analytics
Primary Location US-WI-Wauwatosa
Other Location US-TN-Franklin
Organization Optum Ops-Shared Svcs Analytcs
Schedule Full-time
Number of Openings 5
Apply on the Company Site

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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