Senior Business Analyst

Letterkenny, Co Donegal
Permanent
Full-time

10 days ago

Optum is a global organisation that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.In healthcare, evolution doesn't just happen. It takes innovation, imagination, and a passion for solving problems in new and better ways. And innovation is taking place at a lightning-fast pace every day at Optum. As the fastest growing part of the UnitedHealth Group family of businesses, we're expanding our team in Ireland and creating excellent opportunities for those who want greater purpose and more impact in their work. We'll provide the investment, support, and resources to advance your career. You'll provide the talent, ambition, and drive.Do you believe data can help reshape the future, and you find yourself loving the thrill of diving into challenging work? At UnitedHealth Group, you will find an organisation that will recognise those talents, and you will have lots of growth potential. Here, you will be empowered, supported and encouraged to use analytical and continuous improvement methodologies to help change the future of health care. Does the challenge intrigue you?As a key member of the Risk and Quality Operations (RQO) team, you will play an important role in delivering UnitedHealth Group's mission of helping people live healthier lives. The primary responsibility of this position will be to ensure that a member's risk adjusting claims are evaluated against their coded medical record encounters for the payment year. The Senior Business Analyst will be responsible for processing, evaluating, and validating claims inventory to ensure the Claims Verification process meets the standard as set by the US department of Health & Human Services (HHS) for chart review. As a Business Ops Specialist, you will be challenged to make recommendations as to how performance can be continuously improved. Join us! There has never been a better time to do your life's best work.Schedule: Full-time position with standard working hours of Monday - Friday, 9am - 5pm.Careers with Optum offer flexible work arrangements and individuals who live and work in the Republic of Ireland will have the opportunity to split their monthly work hours between our Dublin or Letterkenny office and telecommuting from a home-based office in a hybrid work model.Primary Responsibilities:

Track and manage Inventory within the EDPS system, Coordinate the deletion of invalid diagnosis codes from CMS systems (RAPS and EDPS) as soon as discrepancies are identified
Monitor CMS reports (e.g., MAO-004) to track which diagnosis codes were accepted, disallowed, or flagged for deletion, communicate findings and deletion actions to internal stakeholders and CMS as required
Ensure deletions are properly documented and traceable, including the reason for deletion and source of error
Track and report Delete Data Delivery results from Optum Insight's EDPS Application to clients
Implement proactive strategies to triage deletes and reduce audit risk before CMS initiates RADV (Risk Adjustment Data Validation) reviews
Demonstrate understanding of standard operating procedures, policies, and processes and how those impact business partners' operations
Assist with maintenance of SOP documentation, process documentation, and reporting controls to meet audit requirements
Develop and maintain relationships across the wider RQO and Risk, Quality and Network Solutions (RQNS) functions to facilitate collaboration and effective communication
Work as part of a team to drive innovation and performance improvements which translate into improved customer outcomes and process efficiencies
Conduct error remediation in advance of CMS/HHS deadlines

You will be rewarded and recognised 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 providing development for other roles you may be interested in.Required Qualifications:

Bachelor's Degree (or higher) OR equivalent experience
Proven experience in business/finance analysis/healthcare with foundational knowledge of Risk Adjustment
Demonstrated experience operating successfully in the absence of established procedures
Experience in Microsoft Office suite of products (Excel, PowerPoint, Power BI etc.)
Understanding of relevant computer systems and platforms (e.g.: reporting systems; financial systems; company shared drives; Knowledge Library)
Intermediate level of proficiency in SQL (Oracle, PL/SQL, SQL, SQL*Plus) with the ability to pull and analyze data, as well as update and alter internal tables
Intermediate level of proficiency with Excel (pivot tables, V or H look ups, data validation, creating internal/external reports)
Ability to research conflicting and/or inaccurate data and determine root cause
Ability to assist with Operational Readiness tasks such as client implementations

Preferred Qualifications:

Foundational knowledge of EDI/837 claim experience
Risk Adjustment experience desired
Ability to communicate analysis including trends and opportunities to business partners both written and verbally
Visio Experience
Proficiency in CMS submission platforms (RAPS, EDPS)
Familiarity with ICD-10 coding guidelines, HCC models, and CMS manuals
Understanding of data governance and compliance protocols
Ability to perform well under pressure, work independently and balance workload to meet customer expectations
Develop and recommend performance and system improvements through user stories and defects

Soft Skills:

Acting independently with minimal supervision
Organizational skills, including the ability to manage multiple tasks, prioritize workloads, and meet deadlines
High levels of drive, determination, and tenacity
Ability to present information clearly, concisely, and confidently to meet the needs of the audience
Proactively identify solutions and work with a team to solve complex problems

Please note you must currently be eligible to work and remain indefinitely without any restrictions in the country to which you are making an application. Proof will be required to support your application.All telecommuters will be required to adhere to the UnitedHealth Group's Telecommuter Policy.At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalised groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.Diversity creates a healthier atmosphere: Optum is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to gender, civil status, family status, sexual orientation, disability, religion, age, race, and membership of the Traveller community, or any other characteristic protected by law. Optum is a drug-free workplace. © 2025 Optum Services (Ireland) Limited. All rights reserved.#RPO

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