Manager, Commercial Data Mining - Remote

Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives?  Join us in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.

Commercial Data Mining focuses on analyzing industry trends, payment policies, contractual agreements, and processed claims data to identify incorrect provider payments made by health insurance payers. Advanced data analytics are developed to support audit activities, validating claim accuracy and payment processes to determine both the root cause and financial impact of overpayments. Our teams ensure recoveries are executed accurately and in a timely manner, delivering measurable value to our clients.

As an Operations Manager on the Commercial Data Mining team, you will drive strategic ideation, establish operational standards, and optimize resource utilization. This role focuses on automating business processes, improving operational efficiency, and building solid client relationships to support both internal performance objectives and external financial goals.

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities:  

• Ensure timely data acquisition and accuracy
• Maintain ideation pipeline
• Prioritize and manage audit production efficiency
• Drive timely recoveries
• Assist in strategic planning and budgeting
• Effectively communicate with, manage, and develop staff 
• Provide reporting and attend meetings with internal and external stakeholders
• Support internal quality assurance efforts

You'll 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 provide development for other roles you may be interested in.

Required Qualifications: 

• 4+ years of healthcare, health insurance, payer operations, claims, payment integrity, or related experience
• 2+ years of experience with healthcare coding guidelines, reimbursement policies, and payment methodologies
• 2+ years of experience communicating with business stakeholders, clients, or leadership
• Proven understanding of healthcare claim adjudication and payer workflows
• Demonstrated understanding of EDI data, including 837 claim submission and 835 payment/remittance data
• Demonstrated ability to work independently and manage multiple priorities through completion
• Proven knowledge of healthcare payment methodologies
• Demonstrated proficiency in Microsoft Office software

Preferred Qualifications: 

• Solid understanding of database logic and software
• Employee management and leadership skills
• Solid presentation skills
• Experience with client engagement
• Experience working within a large organization

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.