Claims Business Process Analyst Senior

About this role

*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.*

At UnitedHealthcare, we're simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and optimized. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

The C&S DSNP Maximum Out-of-Pocket (MOOP) Processor plays a critical role in protecting the member experience by proactively identifying, investigating, and resolving issues impacting Dual Eligible Special Needs Plan (DSNP) members' Maximum Out-of-Pocket accumulators.

This position is responsible for researching and resolving MOOP overages, performing detailed root cause analysis, and identifying trends across claims, accumulators, eligibility, vendor, and system processes. The role serves as a key partner in driving process improvements, reducing regulatory and financial risk, and ensuring DSNP members receive accurate benefits and cost-share protections.

Success in this role requires strong analytical skills, claims adjustment expertise, innovative problem-solving, and the ability to collaborate across internal and external business partners to implement sustainable solutions.

This position is full time (40 hours / week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours 8:00am - 5:00pm. It may be necessary, given the business need, to work occasional overtime.

This will be on the-job-training and the hours of training will be during normal business

Primary Responsibilities:

• Review and work DSNP MOOP overages and accumulator discrepancies.
• Research claim history, benefit configuration, accumulator activity, and eligibility re...