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Senior Operations Analyst - WellMed - San Antonio, TX

UnitedHealth Group

San Antonio, TX
Job Code:
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Senior Operations Analyst - WellMed - San Antonio, TX(Job Number:706510)

This role will prepare you for significant career growth as you shift to a gear you didn't know you had in you. So the contributions you'll make as a Data Analyst at Optum, the pride you will feel, the smile that will keep you company on your way home are all ways that you'll know what you do here really matters. It will be important. No, it will not be just important, it will be historic. That's why someday, you will look back at the things you achieved here and realize that you did your life's best work.(sm)

The purpose of the Senior Operations Analyst is to support the Claims, Credentialing, System Configuration (Benefit, Provider, etc.), Provider Call Center, Claims Delegation Oversight, and Quality Assurance (Claims) departments under Network Operations.  Duties include claims analysis, IKA configuration analysis, EDI analysis, User Acceptance Testing and Quality Assurance for all system patches / upgrades, operational reporting for monthly metrics, budgeting, and forecasting, troubleshooting for all departments as relates getting data into and out of the IKA system, etc. Additionally this role supports the entire encounter data submission process which is a collaborative effort among DataRAP, IT, and Claims. This position plays a major role in the development and implementation of core business systems and processes.

Primary Responsibilities:
  • Analyzes business needs, documents requirements and translates needs into functional, nonfunctional and / or technical specifications according to each department’s needs
  • Analyzes and extracts data from the Enterprise Data Warehouse (EDW) to report to internal and external customers
  • Serves as a key resource to both IT and business units by providing data/analytical support, mentoring, guidance and technical expertise
  • Designs, develops, tests, documents and maintains database queries for ad hoc reporting used in complex conceptual analyses for all departments within Network Operations and for external departments such as Finance (HCE) and IT
  • Develops systematic reporting processes and procedures to ensure timely delivery of weekly, monthly, quarterly, annual and ad hoc reporting to management throughout the company and to Optum (metric reporting)
  • Develop network adequacy reports including GeoAccess data extracting and mapping, comparing to Medicare Adequacy standards, and applying to current network status to identify gaps in WellMed network
  • Develop credentialing reports, roster reporting, and all other ad hoc provider reports needed
  • Delivers requirements, performs analysis, and evaluates downstream business, systems, process and / or organizational impacts
  • Plans and assists with oversight of testing processes and activities including defect identification and resolution
  • Advises the appropriate people on the implications of existing IT systems that can be applied to a problem. Identifies risks and issues, makes recommendations, and seeks approval on complex matters
  • Provides subject matter expertise, reporting support and operational support to internal business partners.  Collaborate with Optum CDQI on project EQMS
  • Conducts focus group interviews, research initiatives and identifies best practice approaches.  Evaluate workflows and develop tools to assist a variety of positions streamline their work to maximize efficiency
  • Will ensure compliance of X12 transactions by running them through EDIFECS, WEDI, SNIP level validator
  • Performs all other related duties as assigned

Job IT Data Warehousing/Analytics
Primary Location US-TX-San Antonio
Other Location 
Organization WellMed Medical Mgmt, Inc
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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