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Job description
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
The Consultant, Healthcare Economics role (Network Pricing & Analytics) is responsible for supporting the development, analysis, implementation, and maintenance of provider reimbursement and network pricing strategies. This role analyzes healthcare claims, reimbursement methodologies, contractual terms, and market trends to support competitive and financially sustainable provider network arrangements. The analyst partners with contracting, clinical, finance, actuarial, operations, and provider relations teams to evaluate pricing impacts, support negotiations, and ensure accurate configuration and implementation of reimbursement models.
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
Analyze provider reimbursement arrangements, fee schedules, and network pricing models
Support development and maintenance of pricing methodologies for professional, facility, ancillary, and value-based reimbursement arrangements
Perform financial modeling and impact analysis related to provider contracts and network initiatives
Manage unit cost entry into UCRT
Evaluate claims utilization, unit cost trends, and reimbursement performance metrics
Prepare pricing analyses and recommendations to support provider negotiations and strategic initiatives
Validate pricing configurations and reimbursement logic within claims and contract management systems
Collaborate with clinical, contracting and provider relations teams to model proposed contract terms and rate changes
Monitor network performance and identify opportunities for cost savings and operational improvements
Develop recurring and ad hoc reports, dashboards, and presentations for leadership and business stakeholders
Ensure pricing compliance with regulatory requirements, internal policies, and contractual obligations
Assist in implementation and testing of reimbursement changes and fee schedule updates
Support data integrity and troubleshooting activities related to pricing and claims reimbursement
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
Bachelor's degree in finance, Healthcare Administration, Economics, Statistics, Mathematics, Business Analytics, or related field
2+ years of analytical experience in healthcare pricing, managed care, provider reimbursement, network contracting, finance, or healthcare analytics
Experience working with healthcare claims and reimbursement methodologies
Knowledge of healthcare payment methodologies include:Fee-for-service
Capitation Reimbursement
Case Rates
Percent of billed charges
Medicare-based reimbursement
Value-based payment models
Advanced proficiency in Microsoft Excel, including Power Pivot, formulas, and financial modeling
Proven solid analytical and quantitative problem-solving skills
Proven solid attention to detail and ability to manage multiple priorities
Proven effective written and verbal communication skills
Proven ability to work collaboratively across cross-functional teams
Preferred Qualifications
Experience with SQL, data visualization tools, or reporting platforms
MHA or NPH degree
Experience in managed care, health insurance, PPO networks, or provider contracting environments
Experience with claims systems, contract modeling software, or reimbursement configuration platforms
Experience using Tableau, Power BI, SAS, Python, or similar analytical tools
Knowledge of CMS reimbursement methodologies and regulatory guidelines
Familiarity with actuarial or healthcare financial analysis concepts
Core Competencies
Financial and reimbursement analysis
Data interpretation and modeling
Critical thinking
Problem-solving
Communication and presentation skills
Project coordination
Attention to detail
Stakeholder collaboration
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.
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Worksite address
cypress, CA, 90630, US
Who can apply
Review the original listing for work authorization, qualifications and employer requirements.