No industry is moving faster than health care. And no organization is better positioned to lead health care forward. We need attention to every detail with an eye for the points
no one has considered. The rewards for performance are significant. You'll help improve the health of millions. And you'll do your life's best work.(sm)
Health Plans face a number of unique environmental pressures that affect the way they will conduct business today and in the future - among them a need for increased privacy and security, an intense focus on risk management, access to capital, efforts to consolidate and streamline IT functions, the launch of new consumer-driven business models, managing chronic diseases through medical management practices, maximizing e-business-driven platforms, implementing health plan-specific customer relationship management tools and complying with increasing financial and transactional legislation. Our healthcare professionals can help clients address these and other challenges in today's complex health care environment.
Optum Payer Consulting currently has openings for a variety of consulting skill sets within our Operational Excellence Practice Area:  First and foremost we are seeking individuals that have worked within a professional consulting organization and/or have worked within a professional consulting organization, that have a strong desire to focus on Health plan operations and who enjoy onsite client consulting interaction.  
Primary Responsibilities:
We are seeking candidates who have deep domain consulting expertise in one or more of the following areas:  

Health Plan Operations

Government Programs - Medicaid, Medicare Advantage, and Medicare Part D

PBM - Third party administrator of prescription drug programs, pharmacy, administration of claims and benefits, drug utilization, distribution, disease management, and volume purchasing

Clinical - Payer disease and utilization management, HIN, ICD10 business processes, technology assessment, planning, remediation and compliance

Core Admin & Project Management  - Cost containment, process improvement, provider contracting, project management and Health Care Reform

Product Development - Market assessments and sizing competitive intelligence, sales management and distribution, network development, and vertical integration

Payment Integrity

Claims Editing

Enrollment Integrity/Coordination of Benefits


Overpayment Identification

Claims auditing

Health care Subrogation / Third Party Liability

Claims Configuration

Lead configuration activities for a core claims administrative system (IKA, QNXT, FACETS, Health Rules, etc.) based on expertise in one or more functional areas (e.g., Product, Provider, Member, Finance)

Lead configuration design activities including direct management of project team members

Participate in design sessions

Participate in test development and execution activities

Provide configuration thought leadership to organization
Ensure that all configuration documentation is prepared, reviewed, and approved