Network Integrity and Quality Team Quality Analyst

Title: Network Integrity & Quality Team Quality Analyst

Requisition number: 2379452

Job category: Project/Program Management

Primary location: Dallas, Texas

Additional locations: Phoenix, Arizona | Minneapolis, Minnesota | Tampa, Florida | Hartford, Connecticut

Overtime status: Non-exempt

Travel: No

Job Description:

This position is National Remote. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. For all hires in Minneapolis, Virginia, Maryland, or Washington, D.C. area, you will be required to work in the office for a minimum of four (4) days per week.

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

The Network Integrity & Quality Team Provider Data Analyst supports the Quality Management and Quality Improvement operational area within the Network Integrity and Performance quality management system. This position is responsible for coordinating, analyzing, validating, and administering provider data quality activities that support operational oversight, quality governance, contractual compliance, and continuous process improvement. The role provides essential operational infrastructure for recurring daily, weekly, monthly, quarterly, and annual quality activities and supports execution of VA CCN quality program requirements, including the Quality Assurance Plan and Quality Assurance Surveillance Plan.

The statements listed below are not intended to be all inclusive of the duties and responsibilities of the position.  Based on leadership decisions and business needs, "all other duties as assigned" will be expected for each position. Create reports, analyze data and identify trends. 

This position is full-time. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8:00 am - 5:00 pm.

We offer weeks of paid training. The hours of the training will be based on schedule or will be discussed on your first day of employment.  

Primary Responsibilities:

• Manage workload assignment, tracking, and coordination for quality team activities, including audit sampling, census management, follow-up actions, and recurring operational deliverables.
• Develop audit sampling populations, administer Audit-the-Auditor activities, support SOC audit processes, and compile audit trend analysis to support quality oversight and audit readiness.
• Maintain and monitor operational quality metrics, operational controls, quality controls, error trends, performance thresholds, and corrective action follow-up activities.
• Build, maintain, and administer Smartsheet workflows, dashboards, scorecards, workflow automation, and quality work management tools that support operational visibility and governance reporting.
• Validate provider and quality data to support reporting accuracy, data integrity, executive decision-making, and contractual quality reporting requirements.
• Support quality governance reporting and operational reviews through statistical process control, control charts, Pareto analysis, performance reporting, and ad hoc operational data analysis.
• Develop and maintain audit workflows that support provider data, provider directory quality reporting, contractual quality deliverables, and continuous process improvement initiatives.
• Uses pertinent data and facts to identify and solve a range of problems within area of expertise
• Works exclusively within a specific knowledge area to include quality and provider data
• Lead and or participate in applicable projects; Prioritizes and organizes own work to meet deadlines
• Provides problem identification, root cause, explanations, solution and information to others on topics within area of expertise
• Training on new and existing processes as needed
• All other duties as assigned 

Primary Skills and Functional Competencies

• Strong analytical, critical thinking, and problem-solving skills with the ability to evaluate operational data, identify trends, and support quality improvement decisions.
• Experience with quality management systems, audit administration, data validation, workflow management, and governance reporting.
• Ability to develop and maintain dashboards, scorecards, work management tools, and reporting mechanisms that support operational oversight and leadership visibility.
• Knowledge of audit sampling, trend analysis, quality controls, corrective action monitoring, and continuous process improvement methods.
• Experience supporting quality, operational oversight, provider data, network operations, credentialing, compliance, or related operational functions with demonstrated understanding of basic quality programs
• Strong attention to detail, organizational skills, and ability to manage recurring deliverables across multiple operational timeframes.
• Ability to collaborate with cross-functional partners and apply sound judgment to nuanced business, quality, and contractual requirements.
• Experience communicating operational risks, findings, and recommendations to leadership and stakeholders.
• Provide input/suggestions into database or system design based on process, information, or regulation changes, or client requirements
• Lead or participate in applicable projects related to design, entry, and/or support of provider data
• Lead or participate in applicable projects related to business rules and procedures
• Identify risks and support risk remediation and business process improvements 
• Supports quality improvement initiatives through research and analysis  
• Identify and update gaps in quality audit processes
• Maintain monthly census of Provider Data Loaders (PDL) for audit purposes
• Create reports and analyze data; Identify trends in provider data errors identified
• Identify error trends, root cause and provide potential solutions

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School Diploma / GED or equivalent work experience
• Must be 18 years of age or older
• 1+ years of experience analyzing and solving customer problems; Experience working independently in less structured environments with moderately complex operational issues
• 6+ months of claims, provider, or data entry experience
• 6+ months of experience working directly with tracking, trending, and reporting on metrics
• 6+ months of experience documenting processes 
• 6+ months of auditing and data analysis experience in quality or related activities 
• Health industry knowledge  
• Ability to work full-time. Employees are required to have flexibility to work any of our shift schedules during our normal business hours of 8:00 am - 5:00 pm

Preferred Qualifications:

• 2+ years of auditing experience 
• Experience in quality auditing
• Experience in VACCN (Veteran Administration Community Care Network) 
• Six Sigma Certification - White Belt
• Healthcare industry experience
• Basic knowledge of process flow mapping and process narrative composition  
• Computer skills with emphasis on Microsoft Excel, Microsoft Access, Microsoft PowerPoint, and Microsoft Visio
• Intermediate level of proficiency with Microsoft Excel

Telecommuting Requirements:

• Ability to keep all company sensitive documents secure (if applicable)
• Required to have a dedicated work area established that is separated from other living areas and provides information privacy.
• Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service.

Soft Skills:

• Excellent interpersonal, communication, and writing skills
• Strong analytical skills and critical thinking skills
• Demonstrated data analysis experience
• Ability to work in a fast-paced dynamic environment
• Ability to generate, analyze, and synthesize quality data
• Ability to organize quality data in appropriate reporting format

*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 hourly pay for this role will range from $24 - $43 per hour based on full-time employment. We comply with all minimum wage laws as applicable.