Medicaid SME Business Analyst - Remote

UnitedHealth Group•Tampa, FL

1d•Remote

About The Position

The Medicaid SME Business Analyst plays a pivotal role in the successful implementation of an Enterprise Data Services (EDS) project by serving as the functional authority on Medicaid program operations and data. This role provides deep subject matter expertise across claims, recipient (eligibility), and provider domains, ensuring that business needs are accurately translated into scalable, high-quality data solutions. The analyst works closely with Agency program staff as well as Optum Data architects, ETL developers, QA teams, and Reporting/analytics partners. The role focuses on understanding how Medicaid programs operate end-to-end and ensuring that the data warehouse accurately represents program rules, workflows, and data relationships that support analytics, operations, oversight, and decision-making. 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 working with Medicaid programs, MMIS, or healthcare analytics
5+ years of experience in Medicaid Claims Processing or similar systems
5+ years of experience supporting Enterprise Data Warehouse or Large-scale data modernization initiatives
5+ years of experience with Microsoft office applications
3+ years of experience in SQL analyzing large healthcare datasets
Willing to travel up to 25%25

Nice To Haves

Experience working directly with state Medicaid agencies or Medicaid system vendors
Experience working in Agile or hybrid delivery environments
Experience working with Azure Dev Ops
Knowledge of Medicaid Enterprise Systems (MES) and modular architectures

Responsibilities

Serve as the Medicaid SME for core domains, including but noted limited to Claims and encounters, Recipient eligibility and enrollment, Provider enrollment and demographics
Interpret Medicaid policy, program rules, and operational workflows and translate them into data and reporting requirements
Develop and maintain key documentation such as Business Requirement Documents (BRDs), Functional Requirement Documents (FRDs), Data mapping and transformation specifications, Business rules and calculation logic etc.
Define and document: Source system dependencies (MMIS, Eligibility & Enrollment systems, Provider systems, MCO files), End-to-end data flows from source to warehouse to analytics, Data quality and completeness expectations
Validate requirements with program, operations, and policy stakeholders
Decompose high level business requirements into detailed work breakdown structures, including user stories, use cases, and implementation tasks.
Collaborate with technical teams to guide the database design aligned to Medicaid business needs and support downstream analytics and reporting
Partner with ETL / ELT developers to review and validate Source-to-target mappings and transformation logic reflecting Medicaid business rules
Partner with data governance teams to define data quality rules, thresholds, and monitoring metrics
Support development of operational, analytic, and performance reporting use cases, such as Utilization and cost analysis, Recipient demographics and enrollment trends, Provider network and service delivery analysis etc.
Ensure data warehouse outputs are usable, well-defined, and aligned with business expectations
Provide SME input to Power BI developers, analysts, and data scientists on proper interpretation of Medicaid data
Act as a key liaison between the different teams such as ETL, Reporting, Data Governance etc.
Facilitate working sessions and design workshops to align on program rules and data usage
Clearly communicate complex Medicaid concepts to technical audiences
Proactively identify risks, dependencies, and gaps in requirements or data readiness
Demonstrates accountability for understanding and aligning with the mission and goals of the role and department; consistently meets objectives while fostering a collaborative, engaged, and high performing team environment.
Leverage enterprise-approved AI tools to streamline workflows, automate tasks, and drive continuous improvement