Senior Provider Data Analyst & Resolution Specialist - Hybrid

Saved 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 in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together.

Serves as a senior data analyst and subject matter expert responsible for investigating and resolving complex provider issues related to claims, contracting, credentialing, and provider data within the behavioral health network. Acts as a key analytical liaison between providers and internal operational teams, conducting root cause analyses, identifying systemic drivers of provider dissatisfaction, and developing data-driven solutions that improve provider satisfaction, data integrity, operational performance, and ease of doing business. Partners across Claims, Provider Services, Finance, IT, and Clinical Operations to address process gaps, improve transparency and responsiveness, and drive sustainable operational improvements that enhance provider experience and network performance.

Location: This role will require working 2 days onsite at 3131 Camino del Rio North, Suite 700, San Diego CA, 92108. If you reside in San Diego, CA, you will enjoy the flexibility of a hybrid-remote* role as you take on some tough challenges.

Schedule: Monday-Friday, 8:30am-5pm PST

Primary Responsibilities:

Issue Investigation & Root Cause Analysis

Investigate and resolve complex provider-reported issues involving claims denials, payment delays, contract configuration, provider data discrepancies, credentialing, and documentation gaps

Conduct root cause analyses across systems, workflows, and departments to identify underlying causes and distinguish isolated incidents from systemic issues

Leverage data and operational trends to identify recurring provider pain points and recommend sustainable corrective actions

Develop standardized workflows and resolution strategies that reduce provider friction and improve operational effectiveness

Provider Analytics, Reporting & Insights

Analyze provider, claims, and operational data to identify trends, risks, service gaps, and drivers of provider dissatisfaction

Develop and maintain dashboards, reports, and ad hoc analyses that monitor provider complaints, escalations, turnaround times, data quality, and operational performance

Identify high-volume issue categories, processing bottlenecks, and opportunities to improve provider experience

Deliver data-driven recommendations that improve provider satisfaction, network performance, operational efficiency, and business outcomes

Cross-Functional Collaboration & Problem Resolution

Partner with Provider Relations, Claims, Contracting, Credentialing, Finance, IT, and Data teams to investigate and resolve complex provider issues

Facilitate cross-functional root cause reviews and support implementation of corrective actions

Establish accountability, clarify ownership, and drive timely resolution of provider escalations

Present findings, trends, and recommendations to both technical and non-technical stakeholders

Provider Data Integrity & Governance

Maintain the accuracy, integrity, and consistency of provider data across multiple systems and source-of-truth platforms

Analyze and resolve data discrepancies affecting claims adjudication, eligibility, contracting, provider records, and reporting

Conduct audits, validation reviews, and quality assurance activities to support compliance and operational accuracy

Support data governance initiatives that improve data reliability and reduce downstream provider issues

Process Improvement & Provider Experience

Identify and implement process improvements that simplify provider interactions and reduce administrative burden

Recommend enhancements to claims, contracting, onboarding, credentialing, and provider data management workflows

Monitor provider feedback, complaints, and escalation trends to identify opportunities for continuous improvement

Develop guidance, job aids, and knowledge resources to improve transparency, responsiveness, and provider satisfaction

Partner with operational leaders to implement solutions that strengthen provider engagement, retention, and overall provider experience

Communication & Subject Matter Expertise

Serve as a subject matter expert on provider operations, data, claims, contracting, and behavioral health network processes

Clearly communicate data findings, issue drivers, business impacts, and recommended solutions

Translate complex technical and operational analyses into actionable insights for operational and leadership teams

Support data-driven decision-making through consultative problem solving and performance analysis

Project & Operational Support

Manage multiple investigations and priorities while meeting established deadlines and service expectations

Support provider-related projects, system enhancements, data quality initiatives, and operational improvement efforts

Participate in provider directory validation, regulatory compliance activities, and network data improvement initiatives

Track provider issue resolution effectiveness and recommend strategies to prevent recurring concerns and improve provider satisfaction

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

3+ years of experience in healthcare analytics, provider data management, provider relations, claims operations, network management, or related healthcare operations

Experience investigating and resolving complex provider issues involving claims, contracting, credentialing, reimbursement, and provider data

Experience analyzing healthcare data and translating findings into actionable business recommendations

Experience working with provider databases and enterprise platforms such as TRES, SmartCare, SharePoint, SQL Server, or comparable systems

Advanced analytical and investigative skills with demonstrated ability to interpret complex datasets, identify trends, conduct root cause analyses, and recommend sustainable solutions

Proven knowledge of healthcare data flows, system dependencies, and impacts on provider operations and claims processing

Preferred Qualifications:

Solid problem-solving, analytical, written, and verbal communication skills

Ability to communicate complex data findings, operational impacts, and recommendations to both technical and non-technical audiences

Proven ability to work independently while effectively collaborating with cross-functional teams

Demonstrated project management, facilitation, and stakeholder engagement experience

Proven ability to manage multiple priorities, investigations, and projects while meeting established deadlines

Ability to influence process improvements and drive issue resolution without direct authority

Demonstrated commitment to improving provider satisfaction, reducing provider friction, and enhancing provider network performance

*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 hourly pay for this role will range from $29 - $52 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are 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 and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.