Required Qualifications:
- 10+ years of Health Care or Health Plan analytical experience
- Extensive experience with SQL servers, SAP, data management systems, including but not limited to Excel, Access, and Microsoft Data Services. Knowledge of CMS rules and regulations, Managed Care payment methodologies, and proficient in MS office products, and Power BI
- Experience working with claims and large healthcare datasets and solid understanding of payer financial models and cost structures
- Experience applying AI enabled analytics tools (e.g., automated insights, predictive modeling, and intelligent reporting features within platforms such as Power BI or SQL based environments) to support healthcare financial analysis and decision making
- Healthcare & Texas Market knowledge with a solid understanding of Medicare Advantage Reimbursement and risk adjustment, ACA Marketplace dynamics, capitation and value-based models. Understanding of: Provider reimbursement methodologies (e.g., % of Medicare, DRG, case rates)
- Proven excellent written and verbal communication skills, solid analytical and problem-solving abilities and high attention to detail
Preferred Qualifications:
- EPIC
- Experience with Power BI or equivalent business intelligence / dashboarding tools to support reporting and visualization needs
- Experience supporting or analyzing value-based care arrangements, including shared savings and shared risk models
- Experience analyzing reimbursement as a percentage of CMS/Medicare rates
- Experience within healthcare payer/provider contracting (medical groups, health plans, ASC, or similar)
- Experience evaluating high-cost drugs or capitation carve-out decisions
- Direct experience leading financial modeling for capitation (professional, global, or POP-based contracts)
- Solid understanding of Medicare Advantage payment structures and reimbursement methodologies, including revenue drivers tied to MA plans
- Demonstrated ability to apply data analytics within payer contracting environments, including working with large datasets and translating insights into financial or strategic recommendations
- Have supported or led modeling/negotiations for value-based care contracts (shared savings, shared risk)
- Have led projects or teams responsible for contract strategy, financial analysis, or payer negotiations (manager-level or higher)
- Have led or owned implementation of payer/provider contracts across cross-functional teams (Finance, IT, Claims, Ops)
- Have used transparency/vendor rate data for negotiation strategy
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 to $193,200 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.