Business Analyst Consultant - AI Transformation

UnitedHealth Group•Eden Prairie, MN

5d•$91,700 - $163,700•Remote

About The Position

At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to now to start Caring. Connecting. Growing together. UMR is seeking Business Analysis Consultants to support the design and implementation of Agentic AI solutions transforming healthcare claims operations. These roles will work closely with product leaders, technology teams, and domain experts to translate complex claims processing rules into clear business requirements, AI prompts, decision logic, and operational workflows. Consultants will play a critical role in enabling AI-driven capabilities that improve claim adjudication efficiency, payment integrity outcomes, and operational accuracy across multiple AI products. 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.

Requirements

5+ years of experience in healthcare payer operations, healthcare consulting, or healthcare technology delivery
3+ years of experience working with healthcare claims processing including eligibility/benefits, claims edits, coding logic, COB, or pricing
Experience writing business requirements, user stories, functional specifications, and acceptance criteria
Experience collaborating with cross-functional teams including IT, product management, and operations stakeholders

Nice To Haves

Experience supporting AI, automation, or advanced analytics initiatives within healthcare payer operations
Knowledge of claims adjudication systems, payment integrity platforms, or healthcare pricing tools
Familiarity with Agile development methodologies and product delivery frameworks
Experience translating policy or clinical guidelines into operational or system rules
Experience working with large payer organizations or TPAs
Exposure to prompt engineering, rule engines, or decision automation platforms
Solid analytical skills with the ability to translate complex operational processes into structured requirements
Solid written and verbal communication skills

Responsibilities

Lead detailed requirements gathering and analysis for AI-enabled claims operations initiatives
Translate healthcare claims policies, SOPs, and operational guidelines into structured requirements, decision rules, and AI prompts
Collaborate with Product, IT, Data Science, UX, Clinical, Pricing, and Payment Integrity stakeholders to design AI-assisted claims workflows
Convert complex claims logic (eligibility/benefits, coding edits, modifiers, COB, authorization rules, contract pricing, bundling/unbundling, and recoupment logic) into testable system requirements
Develop detailed user stories, functional specifications, acceptance criteria, and traceability documentation
Support development and refinement of AI agent prompts, decision logic, and rule configurations used in claims automation workflows
Participate in solution design sessions to ensure business logic is accurately represented in system functionality
Support testing, validation, and operational readiness of AI-enabled claims capabilities
Document business processes, operational workflows, and system interactions for new AI-driven capabilities
Collaborate with program leadership to ensure alignment across multiple Agentic AI products and maintain consistency in requirements standards