Accountable for a team of Business Analysts, Technical Analysts, and Developers responsible for performing comprehensive data review in the identification of overpayment trends and documentation of business requirements for the creation of retrospective and prospective claim payment analytics. The team develops and maintains analytics generating overpayment savings.Primary Responsibilities:• Leads team of Business Analysts and Technical Analysts in end to end processes of prospective and retrospective analytic development and rule automation.• Identifies opportunities to integrate new data, automation, advanced data science, and business model technologies including a cross functional team initiative implementing full automation of claim overpayments per year. • Directs and leads matrixed and cross-functional teams in the completion of complex, large-scale operational efficiency improvements & innovation through product and process reengineering. • Assess the impact of analytic products to improve provider experience and Net Promoter Score (NPS).• Innovates and influences business strategies through the use of quantitative data analysis• Collaborates to build and maintain strong client and matrix partner relationships in the alignment and delivery of payment integrity solutions• Creates, manages, and reports on KPIS/MBOs

Accountable for enterprise business rules strategy and capability development. Primary Responsibilities• Create enterprise strategy and capability needs for 15,000+ business rules from over 50 claim editing tools and applications.• Identifies opportunities to integrate new data, automation, advanced data science, and machine learning technologies to improve enterprise business rules. • Assess the impact of enterprise business rules, editing tools, and analytic products to improve provider experience and Net Promoter Score (NPS).• Innovates new capabilities and influences business strategies through the use of quantitative data analysis.• Directs and leads matrixed and cross-functional teams in the completion of complex, large-scale operational efficiency improvements & innovation through product and process engineering. • Collaborates to build and maintain strong client and matrix partner relationships in the alignment and delivery of enterprise business rule strategies.

Accountable for a large team comprised of Business Analysts, Technical Analysts, Developers, and Managers responsible for performing comprehensive data review in the identification of overpayment trends and documentation of business requirements for the creation of retrospective and prospective claim payment analytics. The team develops and maintains analytics generating overpayment savings of more than $1.5B annually.Primary Responsibilities:• Leads team of 75 Business Analysts, Technical Analysts, Developers, and Managers in end to end processes of prospective and retrospective analytic development and rule automation.• Identifies opportunities to integrate new data, automation, advanced data science, and business model technologies including a cross functional team initiative implementing full automation of 2M+ claim overpayments per year. • Directs and leads matrixed and cross-functional teams in the completion of complex, large-scale operational efficiency improvements & innovation through product and process reengineering. Lead the successful implementation of process improvements reducing the average analytic development time from 171 days to 40 days with a 20% increase in throughput as well as the removal of 3M false positive claim results per year from analytics. • Assess the impact of analytic products to improve provider experience and Net Promoter Score (NPS).• Innovates and influences business strategies through the use of quantitative data analysis• Collaborates to build and maintain strong client and matrix partner relationships in the alignment and delivery of payment integrity solutions• Creates, manages, and reports on KPIS/MBOs

Accountable for Business Analyst managers and teams responsible for performing comprehensive data review in the identification of overpayment trends and documentation of business requirements for the creation of retrospective and prospective claim payment analytics. The team creates and maintains analytics generating overpayment savings of more than $100M per month. Primary Responsibilities• Oversees end to end processes of algorithm and edit rule development• Identify opportunities to integrate new data, automation, advanced data science, and business model technologies • Innovate and influence business strategies through the use of quantitative data analysis• Directs and leads matrixed and cross-functional teams in the completion of complex, large-scale operational efficiency improvements & innovation through product and process reengineering • Collaborates to build and maintain strong client and matrix partner relationships in the alignment and delivery of payment integrity solutions• Assess the impact of analytics and analytic products on member and provider experience

Supports a Payment Integrity business focused on finding medical cost savings for United Healthcare clients. Manages outcomes of various studies that include analyzing, reviewing, forecasting, trending, and presenting information for operational and business planning. Supports operational and strategic business activities. Develops and implements effective/strategic business solutions through research and analysis of data and business processes.Primary Responsibilities• Support business development and strategy through analysis• Client relationship support and escalated issue resolution• Preparation and delivery of business review presentations• Identify, value, and prioritize system enhancement solutions• Assess end user impact through User Acceptance Testing• Process documentation and workflows• Project Management

Leads a large team of Medicaid claim auditors responsible for the review of more than $100 Million in paid claims on a monthly basis with an identification more than $20 Million in overpaid claims.Primary Responsibilities• Forecasting and inventory planning strategy• Employee Development & Retention• Collaborate with Recovery, Quality Assurance & Appeals to Reduce provider abrasion & decrease overpayment recovery time• Prioritize and track all health plan projects, provider contract audits and standard production algorithms• Manage claim inventory to client ID requirements• Conduct vendor analysis to identify appropriate prepay solutions

Responsible for maintaining strong and cohesive provider networks, supporting and developing network growth strategies and claims payment issue resolution.Primary Responsibilities• Network Development• Network Provider Data and Eligibility Analysis• Provider implementation and on-site training• Provider services and issue resolution• Claims investigation and payment issue resolution