Senior SQL Data Mart Developer - Minnetonka, MN(Job Number:700134)
Transform health care and change the way consumers engage with technology.
Sounds like a big challenge, right? Here, at Optum, you have the opportunity to achieve great things while you showcase your passion and technical expertise. You'll be inspired by working alongside some of the most brilliant minds in technology who bring compassion, energy and focus to their work every day on a mission to change health care as we know it. Join us! Come share who you are and start doing your life's best work.(sm)
As a Senior SQL Data Mart Developer in the Optum Data Management business division of UnitedHealth Group, you may participate in one or more of the following type of projects:
Optum Payment Integrity (OPI) services group focuses on recovering overpayments on claims through the identification of overpayments. Overpayment recoveries are determined utilizing Data Mining, Coordination of Benefit, Fraud Waste and Abuse and Subrogation processes.
Data Mining (ARO) analytics process identifies claim overpayments based on a series of algorithms that are consistently being updated. Data Mining identification is enhanced through the use of external vendors and all identifications are subject to quality audit before being loaded into ODAR for recovery. The UPI team seeks to maximize identifications and their collectability while at the same time referring to CCM to prevent future overpayments from occurring.
Fraud Waste and Abuse analytics attempts to identify claims and claim patterns that indicate potential for provider fraud, waste or abuse using sophisticated algorithms and predictive models. Once aberrant billing patterns are identified medical records are requested to support the billing and determinations are made to flag the provider or pay the pended claims. Claims may be flagged both prospectively and retrospectively.
Coordination of Benefits (COB) analytics seeks to achieve prospective claim savings through identifying members whose other group health insurance (typically Medicare or other commercial coverage) is primarily responsible for paying the claim thus reducing the client's liability. The large portion of information must be gathered from the client's members or the other insurer directly and often through telephone contact. COB savings continues for as long as the member has other coverage and coverage with the client.
Subrogation analytics process identifies situations where a member has been injured through another's negligence and attempts to recover (subrogation) or avoid payment (ICC) on claims to make the injuring party responsible. Most common cases involve motor vehicle accidents, Workmen's Compensation, medical malpractice and product liability.
- Engage new challenges and clients with an outgoing and positive attitude
- Write simple to complex SQL programs to extract data for client inquiry and research
- Perform complex data analysis to support research requests by the client
- Write simple to complex SQL programs to extract ad hoc data for monitoring and maintaining data mart operations
- Inquire with upstream data warehouses and source systems to ensure quality receipt and integration of new data on a daily basis
- Utilize data mart production metrics reports to perform research and assess quality of overall data
- Coordinate with development teams, operations teams and clients to enhance operational metric reporting
- Interface professionally with database, Datastage ETL and SAS development teams
- Troubleshoot client and operational issues quickly and comprehensively
- Support, train and mentor fellow analysts and developers
- Improve operational processes
- Works with minimal guidance; seeks guidance on only the most complex tasks
- Function well within a matrix organization (e.g. - supporting multiple leaders)
Job Applications Development
Primary Location US-MN-Minnetonka
Organization Optum Data Management
Number of Openings 1