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Why Join Optum – A Leader Transforming Health Care Through Innovation
At Optum, a division of UnitedHealth Group, we are on a mission to improve health outcomes for millions of people worldwide. By blending cutting‑edge technology, data‑driven insights, and compassionate care, we help individuals access the pharmacy benefits, clinical services, and resources they need to thrive. Our culture is rooted in diversity, inclusion, and equity, and we empower every team member to bring their authentic selves to work. As a remote employee, you’ll enjoy the flexibility of working from anywhere in the United States while collaborating with a global network of talented professionals who share a passion for making health care more accessible, affordable, and effective.
Position Overview – Remote National Claims Business Process Consultant
We are seeking an experienced, self‑motivated professional to join our Claims Operations team as a Remote National Claims Business Process Consultant. In this role you will serve as a critical bridge between our clients, internal stakeholders, and the technology platforms that process health‑care claims across the nation. You will analyze complex business rules, design optimal processes, and ensure data integrity and security while delivering exceptional service to our members and partners.
Key Responsibilities
- Claims System Analysis & Optimization – Conduct detailed assessments of claim processing workflows, identify bottlenecks, and recommend system enhancements that improve speed, accuracy, and compliance.
- Business Rules Management – Review, interpret, and maintain claim business rules, ensuring they reflect current policies, regulations, and payer requirements.
- Capacity Planning & Reporting – Perform capacity analyses, develop forecasting models, and generate actionable reports for senior leadership.
- Customer Needs Assessment – Engage with internal and external customers to understand their requirements, translate them into technical specifications, and propose viable solutions.
- Problem Solving & Issue Resolution – Resolve moderately complex claim‑related issues, provide root‑cause analysis, and implement preventive measures.
- Mentorship & Knowledge Sharing – Coach junior analysts, deliver feedback, and act as a go‑to resource for complex queries and best practices.
- Project Coordination – Lead or support cross‑functional projects, track milestones, and ensure timely delivery of deliverables.
- Compliance & Data Security – Uphold data privacy standards, adhere to UnitedHealth Group’s Telecommuter Policy, and safeguard sensitive information.
- Continuous Improvement – Proactively identify opportunities for process automation, standardization, and innovation.
Essential Qualifications – What You Bring to the Table
- High School Diploma or GED (additional post‑secondary education is a plus).
- Minimum of 4 years of experience analyzing and resolving customer‑focused problems in a call‑center or office environment, using both phone and computer platforms.
- At least 2 years of hands‑on experience working with health‑care claims – understanding claim adjudication, eligibility, and benefits.
- Demonstrated 1+ year of supervisory or team‑lead experience, guiding staff through complex tasks.
- Proven track record of 1+ year coordinating projects or initiatives, managing timelines, and communicating status to stakeholders.
- Strong proficiency with Windows‑based applications; ability to quickly master new, complex software systems.
- Excellent multitasking capability – comfortable handling multiple products, benefit structures, and concurrent priorities.
- Availability to work within the core hours of 8:00 AM – 5:00 PM Central Standard Time, with flexibility for shift coverage as needed.
- Legal eligibility to work in the United States and be 18 years of age or older.
Preferred Skills & Attributes – What Sets You Apart
- Associate’s or Bachelor’s degree in Business Administration, Health Informatics, or a related field.
- Certification in Project Management (PMP, CAPM) or Business Analysis (CBAP, CCBA).
- Hands‑on experience with claims processing platforms such as OptumInsight, Change Healthcare, or TriZetto.
- Familiarity with regulatory frameworks (HIPAA, HEDIS, ACA) and how they impact claims workflows.
- Advanced analytical tools knowledge – SQL, Tableau, Power BI, or similar reporting suites.
- Strong storytelling ability – translating technical findings into clear, actionable recommendations for non‑technical audiences.
- Demonstrated commitment to diversity, equity, and inclusion initiatives.
Core Competencies – Skills for Success
- Analytical Thinking: Ability to dissect complex claim scenarios, identify root causes, and devise data‑driven solutions.
- Communication Excellence: Clear, concise, and persuasive verbal and written communication skills, especially when explaining technical concepts to diverse audiences.
- Customer‑Centric Mindset: Deep empathy for members and providers, coupled with a drive to exceed service expectations.
- Adaptability: Thrive in a fast‑changing environment, embracing new tools, processes, and regulatory updates.
- Leadership & Influence: Inspire confidence, provide constructive feedback, and champion a culture of continuous learning.
- Technical Acumen: Solid understanding of Windows OS, cloud‑based claim systems, and data security protocols.
Career Growth & Development – Your Path Forward
Optum invests heavily in the professional development of its people. As a Remote National Claims Business Process Consultant, you will have access to:
- Comprehensive Onboarding & Training: A 3‑4 week paid training program covering claims fundamentals, system navigation, compliance, and soft‑skill development.
- Continuous Learning Resources: Subscription to LinkedIn Learning, internal knowledge bases, and quarterly workshops on emerging health‑tech trends.
- Career Pathways: Opportunities to advance into senior consulting, claims operations management, product ownership, or strategic analytics roles.
- Mentorship Programs: Pairing with senior leaders who will guide your career trajectory and help you build a robust professional network.
- Professional Certifications Support: Tuition reimbursement and study time for certifications such as PMP, CBAP, or Certified Professional in Healthcare Quality (CPHQ).
Compensation, Benefits & Perks – What We Offer
While exact salary is determined by experience, location, and market factors, the range for this role typically falls between $58,300 and $114,300 annually. In addition to a competitive base salary, you will receive a comprehensive benefits package that may include:
- Medical, dental, and vision coverage with multiple plan options.
- Health Savings Account (HSA) and Flexible Spending Account (FSA) contributions.
- 401(k) retirement plan with generous company match.
- Equity Stock Purchase Program (ESPP) allowing you to purchase company shares at a discount.
- Paid time off (PTO), holidays, and parental leave.
- Wellness programs, employee assistance services, and mental health resources.
- Performance‑based incentive and recognition awards.
- Remote‑work stipend for home‑office setup, high‑speed internet, and ergonomic accessories.
- Access to employee resource groups (ERGs) focused on diversity, inclusion, and community outreach.
Our Remote Work Environment – Flexibility Meets Collaboration
As a telecommuter, you will:
- Maintain a dedicated, private workspace that meets UnitedHealth Group’s security standards.
- Use a company‑approved high‑speed internet connection to ensure reliable access to our secure platforms.
- Adhere to the Telecommuter Policy, which includes regular virtual check‑ins, data‑privacy safeguards, and compliance training.
- Participate in virtual team huddles, knowledge‑sharing sessions, and collaborative project meetings using tools such as Microsoft Teams, Zoom, and Slack.
- Enjoy a results‑oriented culture that values outcomes over “clock‑in” time, giving you the autonomy to manage your day while meeting service level agreements (SLAs).
Diversity, Equity & Inclusion – A Core Commitment
UnitedHealth Group believes that a diverse workforce fuels innovation and improves health outcomes for the communities we serve. We are proud to be an Equal Employment Opportunity and Affirmative Action employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, disability, or any other protected characteristic.
Application Process – How to Take the Next Step
Ready to make a meaningful impact on health care while advancing your career?
- Submit Your Application: Click the “” button below, upload your resume and a compelling cover letter that highlights your claims experience and leadership abilities.
- Screening & Interviews: Our talent acquisition team will review your profile, schedule a virtual interview, and guide you through the assessment process.
- Offer & Onboarding: Successful candidates will receive a competitive offer, followed by an immersive onboarding experience to set you up for success.
Join Us – Shape the Future of Health Care
If you are passionate about leveraging data, technology, and people‑first solutions to transform the claim lifecycle, we want to hear from you. Apply today and become part of a purpose‑driven organization where your expertise fuels better health outcomes for millions.
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