Optum Insight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and revenue growth. Ready to help us deliver results that improve lives? Join us to start Caring. Connecting. Growing together.
This role sits at the intersection of healthcare operations and technology. The Epic Information Systems Quality Analyst interprets payer and provider contract requirements, translates those requirements into Epic system configuration and business rules, and validates that builds process accurately. The role supports risk operations across eligibility, claims, benefits, contracts, provider setup, accounts payable, and payments, with a solid emphasis on quality, documentation, compliance, and successful implementation.
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.
Primary Responsibilities
- Review payer and provider contracts, reimbursement terms, and healthcare business requirements; break complex content into detailed system and operational requirements
- Configure and maintain Epic application builds and business rules supporting claims, eligibility, benefits, contracts, provider setup, payments, and related payer operations
- Perform quality assurance reviews of application builds to verify that configuration is accurate and transactions are processing as intended
- Identify build or processing issues, coordinate corrective action and retroactive claims reprocessing when needed, and support process improvements that reduce recurrence
- Support new features, upgrades, new health plans, new payers, benefit plans, and member implementations from requirements through go-live readiness
- Develop and maintain build documentation, test evidence, quality audit materials, process documentation, and implementation records
- Partner with business operations, IT, project teams, health plans, vendors, clients, and other internal stakeholders to support successful delivery
- Help ensure solutions align with applicable regulatory, health plan, client, and operational requirements
- Use Microsoft Excel for reporting, tracking, contract analysis, validation, and organization of detailed requirements
You'll be rewarded and recognized 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 provide development for other roles you may be interested in.
Required Qualifications
- Current or Epic certification in at least one Epic application or module. The certification may be active or inactive and does not need to be in Epic Tapestry
- 3+ years of experience supporting Epic applications through configuration, build, systems analysis, testing, quality assurance, issue resolution, implementation, upgrades, or production support
- 3+ years of experience in healthcare payer operations, managed care, health plan operations, claims, eligibility, benefits, contract administration, provider reimbursement, or a closely related healthcare business environment
- Experience interpreting complex healthcare business requirements, payer contracts, provider contracts, reimbursement terms, or business rules and translating them into system configuration, workflows, or technical requirements
- Experience reviewing, validating, testing, auditing, or quality-checking system configuration, application builds, business rules, or operational processes
- Intermediate to advanced Microsoft Excel skills for analysis, reporting, tracking, reconciliation, or requirements validation
- Demonstrated ability and willingness to obtain or reactivate role-specific Epic certifications after hire, based on business needs and training availability. The hiring team anticipates completion within approximately one year
- Demonstrated solid analytical skills and attention to detail, including the ability to break complex information into logical components and evaluate whether system outcomes align with requirements
- Ability to travel up to 10%, primarily as needed for Epic training or certification
Preferred Qualifications
- Epic Tapestry experience or certification
- Epic certification or hands-on experience in Contracts, Eligibility, Benefits, Claims, or related payer workflows
- Experience with healthcare payer configuration, claims adjudication, contract implementation, provider reimbursement, or payment operations
- Experience performing root cause analysis and resolving complex application or operational issues.
- Experience supporting system upgrades, new functionality, implementations, testing cycles, or go-live activities
- Experience coordinating retroactive claims correction or reprocessing
- Experience creating build documentation, quality audit records, test scenarios, or implementation documentation
- SQL experience or experience using comparable data-analysis and reporting tools
- Demonstrated ability to communicate effectively with technical and nontechnical stakeholders and to explain detailed business and system information clearly
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $72,800 - $130,000 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
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 marginalized 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.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.