Responsibilities

• Partner with market, growth, product, operations, and external business partners to support growth, renewal, and strategic initiatives for Optum's Program Integrity services and software portfolio
• Develop and present client-specific solutions, including solution mix, pricing approach, value story, implementation considerations, and contract lifecycle support
• Drive execution for new sales opportunities, renewals, RFP responses, sales presentations, software demonstrations, pricing models, and complex vendor or tri-party agreements
• Provide Program Integrity expertise to support business partner integration questions, customer requirements, and cross-functional solution design
• Capture voice-of-customer insights, assess target customer opportunities, review new solution concepts, and support launch readiness for new products and services
• Lead multi-year programs and executive-priority initiatives, including project planning, stakeholder alignment, implementation strategy, and outcome tracking
• Apply analytical and financial problem-solving to large, complex clients, including savings targets, budget and forecasting inputs, and medical or administrative savings opportunities
• Manage key stakeholder relationships before and after implementation to ensure internal and client needs are addressed
• Document processes, procedures, workflows, and client- or system-specific tracking requirements
• Perform solution assessments to identify opportunities within specific accounts and recommend actions aligned to business objectives

Requirements

• Program integrity, fraud, waste and abuse, compliance, auditing, investigations, claims, coding, or payment integrity certification, such as AHFI, CFE, CHC, CPCO, CPMA, CPC, or equivalent
• 7+ years of Program Integrity or Payment Integrity experience, including program management or solution execution
• 5+ years of experience with Medicaid agency, MFCU, or health plan experience across investigations, claims processing, IT, or facility contract configuration
• 5+ years of experience working with healthcare regulations, compliance requirements, and reimbursement methodologies (includes DRG, APC, OCE, ESRD, CAH, CMG, RUG and RBRV)
• 5+ years of experience documenting client operational and technical workflows
• Proficiency with Microsoft Office Suite
• Proven solid communication, influencing, negotiation, and financial analysis skills

Preferred

• 10+ years of Payment Integrity experience
• Experience supporting policy decisions and executive-level discussions
• Proven success leading strategic initiatives, cross-functional teams, client relationships, and complex projects
• Advanced degree, such as MBA or MHA
• Knowledge of emerging payment integrity trends, technologies, platforms, and services, including claims, Medicaid, and Program Integrity systems

Benefits

• 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.