Senior Claims Business Process Analyst

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The Senior Claims Business Process Analyst is responsible for supporting end-to-end claims process oversight, analysis, quality assurance, and process improvement initiatives, partnering closely with various teams to enhance operational effectiveness.

Responsibilities:

• Perform in-depth, end-to-end research, data analysis, and root cause analysis to support claim quality remediation from initial issue identification through resolution
• Own quality assurance activities related to payment accuracy, claim outcomes, and process improvement initiatives
• Evaluate claim scenarios across the Facets platform, workflows, and business rules to identify gaps, trends, and downstream impacts
• Partner with stakeholders to assess system changes, operational process enhancements, and remediation opportunities
• Maintain claims process documentation, workflows, standards, and tracking tools to support consistency and audit readiness
• Support capacity planning, reporting, and trend analysis to drive operational awareness and decision-making
• Use data and claim findings to recommend solutions, improve processes, and support long-term operational effectiveness

Requirements:

• High School Diploma / GED OR equivalent work experience
• Must be 18 years of age OR older
• 2+ years of experience with analyzing and solving business OR customer issues
• 2+ years of experience in conducting end to end audits
• Ability to manage multiple priorities in a fast paced environment
• Proficiency with Windows-based applications and ability to learn complex systems and issues
• Facets experience
• Ability to work full time (40 hours / week) in their respective time zone, Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift, flexible hours schedules during our normal business hours of 6:00 am - 6:00 pm. It may be necessary, given the business need, to work occasional overtime
• Claim adjustment experience
• SharePoint experience