Urwah Admin

Optum

<div>Explore opportunities with Kelsey-Seybold Clinic, part of the Optum family of businesses. Work with one of the nation's leading health care organizations and build your career at one of our 40+ locations throughout Houston. Be part of a team that is nationally recognized for delivering coordinated and accountable care. As a multi-specialty clinic, we offer care from more than 900 medical providers in 65 medical specialties. Take on a rewarding opportunity to help drive higher quality, higher patient satisfaction and lower total costs. Join us and discover the meaning behind Caring. Connecting. Growing together. 
Primary Responsibilities:<ul><li>
Provides strategic leadership and oversight of clinical education, competency assessment, and staff development across multiple Ambulatory Surgery Centers</li><li>
Develops and manages education programs that strengthen clinical excellence, promote compliance, and enhance patient outcomes</li><li>
Working collaboratively with nursing, operations, and quality teams, the Senior Manager fosters a culture of learning, professional growth, and continuous improvement across the ASC network</li></ul> 
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:<ul><li>
Bachelor of Science in Nursing (BSN) or higher</li><li>
RN license to practice in Texas</li><li>
Current Basic Life Support (BLS) certification</li><li>
7+ years of experience in patient or staff education, including development of continuing education programs</li><li>
7+ years of clinical management experience</li><li>
Proficiency in Microsoft Office Suite, Learning Management Systems (LMS), and digital communication tools.</li><li>
Demonstrated problem-solving, analytical, organizational, and communication skills</li></ul> 
Preferred Qualifications:<ul><li>
Master's degree in nursing education</li><li>
Specialty certification(s) in nursing education or ambulatory care</li><li>
Current Basic Life Support (BLS) Instructor certification</li><li>
10+ years of nursing administration experience with a focus on clinical education and ambulatory surgery center operations</li><li>
Advanced communication and public relations skills, with experience using medical equipment common to ASCs</li><li>
Working knowledge of the Texas Nurse Practice Act, Texas Board of Nursing (TBON) regulations, and nursing peer-review processes</li><li>
Proven solid clinical and personnel management skills</li><li>
Demonstrated problem-solving, analytical, organizational, and communication skills</li></ul> 
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 $89,900 to $160,600 annually 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 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. 
OptumCare 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. 
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.</div>

Sr Manager - Clinical Education Programs - ASC Main Campus - Kelsey Seybold Clinics

<div>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. 
We are searching for a Senior Financial Claims Analyst (Pharmacy / Benefits) at OptumRx. This is an internal facing role, meaning you will be working directly with our operational partners. This position requires a high level of analytical skill and unique expertise of benefits. As a key resource, you must maintain a high degree of accuracy along with attention to detail, excellent oral and written communication skills, solid personal work ethic and the ability to manage time to meet deadlines. Solid task prioritization skills and critical thinking skills are a must! 
Success in this role will require the following:<ul><li>
Detail oriented (specifically focused on data accuracy and presentation)</li><li>
Ability to manage time efficiently and prioritize effectively to adhere to deadlines</li><li>
Ability to multitask in a dynamic setting, flexible to changes, and maintain focus under pressure</li><li>
Solid organizational skills to track requests and deliverables</li><li>
Must be pro-active and have good problem-solving skills</li><li>
Ability to work both independently and within a team setting</li><li>
Ability to learn quickly and desire to take on new challenges</li><li>
Solid desire to make continuous improvements in all areas of responsibility</li><li>
Ability to follow-through, be resourceful and self-driven</li></ul> 
Ideally, we are looking for this person to join us in our Cypress, CA office, but we may consider other locations or a telecommuting role for a stellar candidate residing in another location 
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:<ul><li>
Communicate and collaborate with our team</li><li>
Support client issue remediation by reviewing and analyzing pharmacy claims (calculating before and after scenarios)</li><li>
Review external auditor findings, for either agreement or disagreement</li><li>
Research, analyze, and evaluate claims data to identify patterns and validate accuracy</li><li>
Work closely with the client account team and other functional departments</li><li>
Provide explanations, interpretations, and recommendations for reporting results as needed</li><li>
Support various projects with financial impacts as needed</li></ul> 
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:<ul><li>
4+ years of experience in an analytical role related to Finance, Claims, Pharmacy, or PBM</li><li>
2+ years of experience analyzing large data sets (ie claims) to find patterns, errors, trends, anomalies (pharmacy, finance, or accounting preferred)</li><li>
Expertise in data scrubbing and manipulation to identify and resolve inconsistencies and anomalies with the ability to demonstrate before and after scenarios</li><li>
Proven solid Microsoft Excel Skills (e.g., complex conditional formulas, nested formulas, V-lookups, pivot tables, etc.)</li></ul> 
Preferred Qualifications:<ul><li>
Financial/Accounting/Remediation experience</li><li>
Experience with SQL: knowledge of tables and joins, writing query statements</li><li>
Experience with RxClaim</li><li>
Experience in Microsoft Access: create tables, queries, joins, data manipulation</li><li>
Knowledge of PBM and pharmacy benefit structure</li><li>
Proven self-directed, works with minimal guidance, but recognizes when guidance needed</li></ul><ul><li> 
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy</li></ul> 
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 $71,200 to $127,200 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.</div>

Sr Financial Claims Analyst PBM or Benefits - Remote

<div>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. 
As a Software Architect at Optum Serve, you will be responsible for designing and implementing robust, scalable, and high-performance software solutions. You will work closely with the Business Architecture Analyst to break down conceptual designs into Software Architecture Diagrams, then work with cross-functional teams to ensure that our applications meet the highest standards of quality and performance. Your expertise in modern design patterns, cloud-native architectures, and Microsoft Azure will be crucial in driving our projects to success. 
This role will work with the Business Architect Analysts to take high level designs and break them into EPICs and deliver a software architecture diagram to the teams to help them more rapidly understand the requirements so that they can quickly refine into features and PBIs. 
If you are located in Hybrid in MN, you will have the flexibility to work remotely*, as well as work in the office as you take on some tough challenges. 
Primary Responsibilities:<ul><li>
Design and develop software architectures using modern design patterns such as SOLID principles and Domain-Driven Design (DDD)</li><li>
Collaborate with development teams to create high-quality, maintainable code using .NET and Angular</li><li>
Provide technical guidance to the engineering team regarding the software design, promoting best practices and continuous improvement</li><li>
Conduct architectural reviews and ensure alignment with business goals and technical requirements</li><li>
Stay up-to-date with the latest industry trends and technologies, and apply them to improve our software solutions</li><li>
Work closely with stakeholders and the Business Architects (BAA) to understand and translate their needs into technical solutions</li></ul> 
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:<ul><li>
5 + years of experience as a Software Architect or similar role, with a strong background in software development, software design, and software architecture</li><li>
5+ years of experience in .NET and Angular frameworks</li><li>
5+ years of experience with the following design patterns: Domain-Driven-Design, Event-Driven-Architecture, Clean Architecture, and Command Query Responsibility Segregation (CQRS)</li><li>
5+ years of experience with microservice application design</li><li>
5+ years of experience with containerization and orchestration tools (e.g., Docker, Kubernetes)</li><li>
US Citizenship</li></ul> 
Preferred Qualifications:<ul><li>
Bachelor's or Master's degree in Computer Science, Software Engineering, or a related field</li><li>
5+ years developing and/or architecting solutions for agencies within the Department of Defense or Department of Veterans Affairs</li><li>
3+ years of experience with NIST and SOC security frameworks</li><li>
3+ years of networking principles in Cloud environments.</li><li>
2+ years of monitoring tools such as Elastic Search, Prometheus, and Open Telemetry</li><li>
2+ years of experience with broker systems such as Kafka and RabbitMQ</li><li>
2+ years of modernizing legacy systems</li><li>
2+ years of experience integrating with various technologies and third party systems</li><li>
Experience with cloud-native architectures and Microsoft Azure</li></ul><ul><li> 
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy</li></ul> 
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 $110,200 to $188,800 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. 
OptumCare 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. 
OptumCare is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.</div>

Software Architect - Hybrid in MN or Remote

<div>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. 
Primary Responsibilities:<ul><li>
Under manager supervision, a Senior Tech Support Analyst provides data analytics to the Help Desk Manager and helps oversee a team of Tech Support Specialists. As a &quot;Team Lead&quot;, they provide Coaching Sessions for techs, run daily \ weekly \ monthly metric reports, and assist with escalated issues from Help Desk techs \ end users. Working closely with the Help Desk Manager they will be the primary point of contact for team related questions, concerns, and general guidance. They will also use AI such as Copilot to help analyze trends and reports to better assist Tech Support Specialists with their daily duties.</li><li>
Working directly under the Help Desk Manager, the Sr Tech Support Analyst will be responsible for running all Metrics and Reports requested. They will work with the Help Desk Manager to analyze the reports and provide feedback to the Tech Support Specialists.</li><li>
These Reports include:<ul><li>
Call Metrics (ASA, CAR, AHT, TTCR, QAS, ACW, etc.)</li><li>
FCR Training and Learning Opportunities</li><li>
NPS Survey Follow Ups</li></ul></li><li>
The Senior Tech Support Analyst will also be part of weekly one on ones with Tech Support Specialists providing feedback and scheduling sessions for coaching and growth. The Sr Tech Support Analyst will also be part of the weekly On Call rotation to assist with afterhours escalations</li><li>
The Senior Tech Support Analyst will also be responsible for the training and onboarding of new Support Specialists added under their manager. The Sr Tech Support Analyst will also be a backup on the phones \ chat in the event of a major outage or system failure and perform any other job duties as assigned</li> 
<li>
Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regard to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so</li></ul>
Required Qualifications:<ul><li>
Higher Secondary/Senior Secondary School Diploma</li><li>
3+ years of experience with Computer Repair / Troubleshooting</li><li>
3+ years of experience in Customer Service</li></ul> 
Preferred Qualifications:<ul><li>
Active Directory experience</li><li>
IT / Computer Call Center experience</li><li>
Quick learner and able to multitask</li></ul> 
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.</div>

Senior Technical Support Analyst

<div>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. 
Primary Responsibilities:<ul><li>
Lead the design and development of scalable, AI-enabled applications using modern AI/ML technologies</li><li>
Own the end-to-end lifecycle of AI/ML solutions, ensuring seamless integration, scalability, and performance</li><li>
Architect and maintain robust backend services using Python and Java frameworks (e.g., FastAPI, Spring), with a focus on performance and security</li><li>
Build intuitive front-end interfaces using React.js to deliver seamless user experiences</li><li>
Apply best practices to develop secure, cloud-native solutions aligned with real-world use cases (Azure/Google Cloud)</li><li>
Evaluate existing systems and propose architectural enhancements with detailed technical design documentation</li><li>
Collaborate with Product Owners, Scrum Masters, and SMEs to translate business needs into technical solutions</li><li>
Facilitate technical design walkthroughs and gather actionable feedback from stakeholders</li><li>
Plan and execute comprehensive testing strategies, including automation and performance testing</li><li>
Provide production support, including real-time debugging and root cause analysis</li><li>
Ensure system stability through proactive monitoring and long-term fixes</li><li>
Manage task priorities effectively within Agile frameworks</li><li>
Stay current with emerging AI/ML technologies and industry trends</li><li>
Drive innovation by exploring new tools and techniques to improve scalability and performance</li><li>
Comply with company policies, including flexibility in work location and team assignments</li><li>
Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so</li></ul>
Required Qualifications:<ul><li>
6+ years of software development experience, with 2+ years in AI/ML engineering</li><li>
6+ years of full-stack development experience with React.js and backend APIs</li><li>
3+ years of cloud deployment experience (preferably GCP)</li><li>
3+ years in DevOps and CI/CD (Jenkins, Git, Terraform, etc.)</li><li>
Solid experience in backend development using Python or Java, including FastAPI or Spring</li><li>
Experience with RESTful APIs and event-driven architectures (Kafka, Redis)</li><li>
Experience across software development lifecycle</li><li>
Solid understanding of microservices and service-oriented architecture</li><li>
Familiarity with AI/ML techniques such as NLP, computer vision, and LLMs</li><li>
Proficiency in RDBMS and/or NoSQL databases</li><li>
Proficiency in Python (preferred) and working knowledge of R or similar</li><li>
Proven ability to leverage and guide teams in adopting coding assistants such as GitHub Copilot to enhance productivity and code quality</li><li>
Proven expertise in performance optimization for real-time systems</li><li>
Proven solid communication and presentation skills</li></ul> 
Preferred Qualification:<ul><li>
Experience with building AI agents using Google ADK</li></ul> 
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.</div>

Senior Software Engineer I - Java or React

<div><div>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.</div><div></div><div> 
Schedule: Monday to Friday, 8 AM- 5 PM EST or CST</div><div></div><div> 
Location: Remote- Nationwide</div><div></div><div> 
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.</div><div></div><div> 
Primary Responsibilities:</div> 
<div></div><ul><li>
Help process provider applications and re-applications including initial mailing, review and loading into the database tracking system</li><li>
Ability to submit 10 to 15 provider enrollment applications</li><li>
Preparing, processing, and maintaining new provider and group enrollments</li><li>
Conduct audits and provide feedback to reduce errors and improve processes and performance</li><li>
Demonstrate great depth of knowledge/skills in own function and act as a technical resource to others</li><li>
Solve complex problems on own; proactively identifying new solutions to problems</li><li>
Initiate and assist with developments/changes to increase or change quality and productivity</li><li>
Act as a facilitator to resolve conflicts on team</li><li>
Perform as key team member on project teams spanning more than own function</li></ul>
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:<ul><li>
High School Diploma / GED (or higher)</li><li>
5+ years of experience in submitting at least 10-15 behavioral health commercial/government provider enrollment applications</li><li>
5+ years of experience submitting with follow ups and issue resolution</li><li>
2+ years of experience with submitting provider enrollment applications for Medicare/Medicaid</li><li>
2+ years of experience working with compliance workflows and processes, including NCQA policies and practices</li><li>
2+ years of experience in researching and applying government regulatory information</li><li>
Live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service</li><li>
Access to a designated quiet workspace in your home (separated from non-workspace areas) with the ability to secure Protected Health Information (PHI)</li><li>
Ability to work a 40-hour work week from 8:00 am to 5:00 pm EST or CST</li><li>
Ability to be on camera during Microsoft Teams meetings</li></ul>
Preferred Qualifications:<ul><li>
Extensive knowledge of commercial, Medicaid, and Medicare provider enrollment applications</li><li>
Intermediate level of proficiency with MS Excel and Word</li></ul>
Soft Skills:<ul><li>
Effective time management and ability to multi-task</li><li>
Demonstrated ability to successfully work in a production environment</li><li>
Keen attention to detail</li><li>
Self-starter</li><li>
Ability to be on camera during Microsoft Teams meetings</li><li>All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.</li></ul> 
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 $20.00 to $35.72 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. 
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. 
#RPO #GREEN</div><div></div>

Senior Provider Enrollment Representative

<div>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. 
Primary Responsibilities:<ul><li>
AI/ML Strategy &amp; Implementation: Develop and execute a cutting-edge AI/ML strategy specifically tailored to enhance healthcare claims processing, improve operational efficiency, and reduce costs. Lead the end-to-end implementation of AI/ML solutions, from ideation and model development to deployment and ongoing optimization</li><li>
Healthcare Claims Domain Expertise: Leverage deep knowledge of the healthcare claims lifecycle, including claims processing, adjudication, encounters, appeals and grievances and operations. Apply this domain expertise to identify opportunities for data science and AI to solve critical business problems within this space</li><li>
Strategic Leadership &amp; Vision: Define and communicate a clear vision for how data science and AI will transform claims processing and operations. Drive innovation by identifying and championing new analytical approaches and technologies that can provide a competitive advantage</li><li>
Team Leadership &amp; Development: Build, mentor, and manage a high-performing team of data scientists, ML engineers, and data analysts specializing in healthcare claims data. Foster a culture of continuous learning, experimentation, and best practices in AI/ML development and deployment</li><li>
Cross-Functional Collaboration: Partner closely with Claims Operations, IT, Finance, and other key stakeholders to understand business needs, translate them into data science problems, and deliver impactful solutions. Effectively communicate complex AI/ML concepts and results to both technical and non-technical audiences, including executive leadership</li><li>
Data Management &amp; Governance: Oversee the acquisition, cleaning, and management of complex healthcare claims datasets. Ensure data quality, integrity, and compliance with relevant regulations (e.g., HIPAA)</li><li>
Performance Monitoring &amp; Optimization: Establish key performance indicators (KPIs) for AI/ML models and data science initiatives related to claims processing. Continuously monitor model performance, identify areas for improvement, and implement strategies for ongoing optimization</li><li>
Enterprise Strategic Leadership Focus<ul><li>
Develop and execute org-wide AI/ML strategy, Data strategy aligned with company business goals, Roadmap, and technology transformation</li><li>
Lead enterprise AI/ML strategy for HealthCare analytics, claims automation, and operational excellence</li><li>
Collaborate across functions-product, technology, operations, regulatory, executive leadership - to convert strategic priorities into scalable initiatives</li></ul></li><li>
Technical Innovation &amp; Delivery Focus<ul><li>
Lead design, development, and hands-on implementation of advanced AI/ML solutions, including LLMs, Agentic AI, MCP, Generative AI, multimodal models, and predictive analytics, for real-world healthcare applications</li><li>
Oversee enterprise-scale ML infrastructure, MLOps pipelines, and cloud integrations (AWS/Azure/GCP)</li><li>
Present outcomes, roadmaps, and technical vision to board and senior leadership, shaping strategic direction through data and impact stories</li><li>
Proven delivery of scalable, production-quality AI systems with measurable business value</li><li>
Deep technical proficiency in ML frameworks, Python, cloud platforms, and responsible AI practices</li><li>
Exceptional communication and stakeholder management skills for both executive and technical audiences</li></ul></li><li>
Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regard to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so</li></ul>
Required Qualifications:<ul><li>
Master's in a quantitative field such as Statistics, Computer Science, Mathematics, Data Science or a related discipline. Prior solid understanding of healthcare operations is a plus.</li><li>
Experience:<ul><li>
18+ years of progressive experience in data science, with a significant focus on AI and Machine Learning.</li><li>
5+ years of experience in a leadership role, managing and mentoring data science or AI/ML teams.</li><li>
Demonstrated success in developing and implementing AI/ML solutions (including Gen AI, Agentic AI, MCP, A2A) that have delivered measurable business value, preferably within the healthcare industry</li></ul></li><li>
Technical Skills:<ul><li>
Experience with big data technologies (e.g., Spark, Hadoop) and cloud platforms (AWS, Azure, GCP) for building and deploying AI/ML solutions</li><li>
Expertise in a broad range of AI/ML techniques, including supervised and unsupervised learning, deep learning, natural language processing (NLP), and time-series analysis, etc., preferably with a focus on their application to claims data</li><li>
Proficiency in programming languages and tools like Python or R, Agentic AI, Model Context Protocol (MCP), Agent to Agent Protocol (A2A) and relevant libraries (e.g., scikit-learn, TensorFlow, PyTorch, Keras, XGBoost)</li><li>
Familiarity with data warehousing, ETL processes, and database management (SQL)</li><li>
Understanding of MLOps principles and tools for model deployment and lifecycle management</li></ul></li></ul> 
Leadership &amp; Soft Skills:<ul><li>
Exceptional leadership, strategic thinking, and people management skills, with the ability to build and inspire high-performing teams.</li><li>
Solid ability to translate complex business challenges in healthcare claims processing into actionable data science and AI solutions.</li><li>
Excellent communication, presentation, and stakeholder management skills, with the ability to influence and gain buy-in from executive leadership and cross-functional teams.</li><li>
Deep understanding of data governance, privacy, and security in the healthcare context (e.g., HIPAA compliance).</li><li>
Proactive, results-oriented, and a passion for driving innovation in the healthcare domain.</li></ul> 
Preferred Qualification:<ul><li>
Deep expertise in the healthcare claims domain, including a thorough understanding of claims processing, operations, medical billing, coding, and related regulatory frameworks</li><li>
Proven track record of leveraging healthcare claims data (e.g., X12, HIPAA 837/835) for analysis and model development</li></ul> 
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.</div>

Senior Director Data Science

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