Senior Healthcare Claims Analytics Analyst - Remote
About The Position
The Optum Serve Community Care Network (CCN) team is seeking a highly experienced Senior Healthcare Claims Analytics Analyst to support claims oversight, payment integrity, reimbursement policy analysis, and strategic analytics for the Department of Veterans Affairs (VA) Community Care program. This role serves as a senior analytic expert responsible for managing complex claims data requests, conducting investigations, performing impact assessments, and supporting executive decision-making across a wide range of operational, financial, payment policy, and regulatory topics. The individual will partner closely with Claims Oversight, Payment Integrity, Finance, Clinical Operations, Compliance, Technology, and VA stakeholders to develop data-driven insights and recommendations. The ideal candidate brings experience supporting large healthcare organizations, federal healthcare programs, or Veterans Health Administration (VHA) operations and has demonstrated success managing urgent executive-level data requests, coordinating analytic teams, and translating complex business questions into actionable analyses. This position functions within the Claims Analytics & Insights capability of the Claims Oversight organization and plays a key role supporting payment policy implementation, CDI initiatives, VA inquiries, claims modernization efforts, and analytic governance activities. 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
- 7+ years of healthcare analytics experience
- 5+ years of experience working with healthcare claims data
- Experience supporting Medicare, Medicaid, VA, TRICARE, commercial payer, or federal healthcare programs
- Advanced SQL experience
- Experience developing complex analytic methodologies and quantitative analyses
- Demonstrated ability to manage multiple high-priority requests simultaneously
- Solid written and verbal communication skills
Nice To Haves
- Veterans Health Administration (VHA) experience
- Experience supporting executive leadership, Congressional/Hill inquiries, regulatory reporting, audit support, or enterprise-level operational reporting
- Experience leading or overseeing teams of analysts
- Experience responding to urgent operational data requests and executive reporting requirements
- Experience with healthcare reimbursement methodologies, payment policy analysis, and claims adjudication processes
- Experience with Palantir, Tableau, Power BI, SAS, Python, R, Databricks, or other advanced analytics platforms
- Familiarity with VA Community Care, Medicare fee schedules, payment policy, CDI, and payment integrity concepts
Responsibilities
- Serve as a senior analytic advisor supporting leadership, Claims Oversight, Payment Integrity, and VA stakeholders
- Manage and prioritize complex analytic requests requiring rapid turnaround and executive visibility
- Conduct data-driven investigations related to claims processing, payment accuracy, reimbursement methodologies, provider billing patterns, and operational performance
- Develop executive-ready reports, presentations, and briefing materials
- Perform detailed claims analyses to quantify financial, operational, provider, and member impacts
- Evaluate claim populations, payment outcomes, trends, root causes, and reimbursement methodologies
- Support cost, utilization, payment policy, and claims integrity analyses
- Conduct impact assessments associated with policy changes, CDI implementation, fee schedule updates, claims edits, and reimbursement methodologies
- Support VA analytic inquiries from intake through final response
- Translate business questions into analytic approaches and data requirements
- Work with claims SMEs to validate findings, quantify impacts, and prepare VA-ready responses
- Coordinate data requests across internal and external partners as needed
- Support development and maturation of the Claims Analytics intake and triage process
- Help define analytic requirements, scope, methodologies, and success criteria
- Ensure consistency, quality, traceability, and documentation across analyses
- Support ServiceNow and intake governance processes for claims analytics requests
- Partner with Claims Operations, Payment Integrity, Finance, Clinical Operations, Provider Services, Compliance, and Technology teams
- Work closely with data engineering and analytics teams to develop queries, reports, dashboards, and monitoring tools
- Participate in cross-functional workgroups related to payment policy implementation, claims modernization, and operational improvements
- Provide guidance and mentorship to analysts supporting claims initiatives
- Review analytic work products and promote analytic standards and best practices
- Coordinate activities across multiple stakeholders and competing priorities
- Serve as a trusted resource for complex analytic and claims data questions
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
