Exploratory Ideation Manager

Letterkenny, Co Donegal
Permanent
Full-time

21 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.This role performs exploratory ideation analysis activities related to the Data Mining Growth programs. The incumbent will lead reviews for all types of medical claim payments against contracts, system configurations, client policies, and regulations providing expertise and provide direction to the team.The incumbent will produce and develop ad-hoc reporting, new business implementations, client system migrations and client referrals to validate provider contractual terms in conjunction with client systems. The objective is to identify claim pricing defects, collaborate with various matrix business partners to remediate technical, procedural or compliance related errors.The Exploratory Ideation Manager is responsible for achieving incremental savings (post pay) via various claim data and trend analysis with accountability to identify, develop and deploy new concepts/themes. A key lead in the team to drive incremental value with effective deployment of concepts, applying technical knowledge with development and implementation of outlier detection models.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:

Solves complex problems and develops innovative solutions utilizing various sources of intelligence and information.
Performs complex conceptual analyses and identifies action plan solution.
Lead functional or segment teams or projects and manage team of analyst
Oversight and effective pipeline management, ensuring compliance to quality with expedited deployment.
Lead role to progress concepts through the various business approval stages (PICOG/Executive approval etc.)
Develop claims outlier detection models, utilizing specialist skills across the enterprise.
Identify, build and deploy various tools/utilities to assist with the identification of overpaid claims (i.e. Power Bi, Tableau)
Effective data analysis of claims paid data to identify leads for analysts to develop into concepts.
Key accountability to ensure that pre-pay solutions are implemented to prevent re-occurrence of claims being overpaid.
Quickly identify payment errors regardless of claim system by means of effective data analysis.
Lead and develop new ideation and Growth techniques and skills, utilizing various business and external sources of intelligence/knowledge.
Develop technical solutions to identify claim outliers, working with business partners such as Data Science

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)
Proven healthcare experience working with UHC Claim paid data
Hands-on experience working with processing or reviewing medical claims in respective platform (primarily M&R or C&S)
Hands-on experience using at least one of the following claims platforms: UNET, NICE, CSP, or Cosmos
Experience analyzing large UHC claims data sets to determine trends / patterns
Ability to understand various applications to identify claim spend anomalies
Beginner level proficiency with Power BI/SQL/Tableau
Experience reading and interpreting provider contracts, fee schedules, and claim payment policies

Preferred Qualifications:

Proficient working with Microsoft Excel including formulas, calculations, charts, graphs, etc.
Experience in Data Mining Post pay
Effective demonstration of management capabilities across multiple disciplines
Knowledge on PICOG Process guidelines
Experience with Reimbursement and Medical policies

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.For more information on our Internal Job Posting Policy, click .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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