Optum Tech is a global leader in health care innovation. Our teams develop cutting-edge solutions that help people live healthier lives and help make the health system work better for everyone. From advanced data analytics and AI to cybersecurity, we use innovative approaches to solve some of health care's most complex challenges. Your contributions here have the potential to change lives. Ready to build the next breakthrough? Join us in making healthcare work better for everyone through people-led, responsible AI while
Caring. Connecting. Growing together.The Principal Business Data Consultant- RxMax Support - serves as the primary technical and business-facing expert for the RxMax application and associated data ecosystem. This role partners closely with business stakeholders, operations teams, vendor partners, and technology teams to investigate complex business scenarios, analyze claim rebate and reimbursement processes, troubleshoot production issues, and provide data-driven solutions.
Unlike a traditional development role, this position does not have access to the application codebase and is not responsible for software development. Success in this role requires a deep understanding of the RxMax application, healthcare claims processing, business rules, data flows, and reporting structures. The Principal Data Engineer leverages advanced SQL and analytical skills to trace claim processing, validate calculations, identify root causes, and recommend solutions to complex business and operational problems.
We are looking for candidates who can combine deep business knowledge with solid technical data analysis capabilities. This person will investigate a claim from initiation through final calculation, explain every processing step, determine why a specific outcome occurred, and provide practical recommendations to address issues. They should be naturally curious, skilled at navigating ambiguity, and able to bridge the gap between business operations and technology teams without requiring direct access to application source code.
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: - Serve as a subject matter expert (SME) for the RxMax application, claims processing workflows, and supporting data structures
- Partner with business stakeholders to understand complex operational challenges and translate them into actionable data analysis and solution recommendations
- Investigate end-to-end claim processing and payment workflows to identify root causes of issues, discrepancies, and unexpected outcomes
- Analyze claims, billing, payments and disbursement financial data to understand calculation methodologies and validate business results
- Trace data across multiple systems and processing stages to determine how claims are transformed, adjudicated, and reported
- Perform in-depth data analysis using SQL and other analytical tools to research issues and answer business questions
- Document business processes, data flows, calculation logic, decision points, and operational impacts
- Provide production support by researching incidents, resolving data-related issues, and recommending corrective actions
- Collaborate with development, product, business, and vendor teams to communicate findings and facilitate issue resolution
- Identify opportunities to improve data quality, operational processes, business controls, and support procedures
- Develop and maintain detailed knowledge of claim lifecycle events, data lineage, system integrations, and reporting dependencies
- Support audits, compliance reviews, and executive inquiries by providing accurate data analysis and traceability
- Create clear and concise documentation, root cause analyses, process maps, and business impact assessments
- Mentor team members and provide guidance on data investigation methodologies and best practices.
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: - 5+ years of experience working in production data environments while maintaining data accuracy, governance, and security standards
- 5+ years of advanced proficiency in SQL and languages such as Python, Scala, or Java
- 5+ years of experience working with cloud data platforms (e.g., AWS, Azure, or Snowflake) and big data processing frameworks (e.g., Spark or Databricks)
- Experience working with or supporting financial systems and financial data architectures
- Experience in the healthcare industry and familiarity with healthcare data models and standards (e.g., HL7, FHIR, HIPAA compliance)
- Demonstrated experience working with business team from an operational standpoint
- Demonstrated experience utilizing digital and productivity-enhancing tools to streamline engineering workflows and problem-solving
Preferred Qualifications: - Experience working with pharmacy benefits management (PBM), healthcare claims, reimbursement, or pharmacy data
- Demonstrated knowledge of claim adjudication, financial reconciliation, and contract pricing methodologies
- Experience with Azure, data lakes, data warehouses, and enterprise analytics platforms
- Demonstrated familiarity with healthcare data standards and regulatory requirements
- Experience collaborating with cross-functional teams in complex healthcare environments
- Demonstrated knowledge of reporting and business intelligence tools
Core Competencies- Business Acumen
- Data Analysis and Investigation
- Root Cause Analysis
- Healthcare Claims Expertise
- Application Knowledge
- Problem Solving
- Stakeholder Management
- Process Documentation
- Data Lineage Analysis
- Communication and Influence
- Operational Excellence
- Strategic Thinking
*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 $112,700 - $193,200 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 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.
