Manager, Commercial Data Mining - Remote

Optum; Plymouth (MN); Hybrid; USD 90,000 - 130,000; Full time

Job summary

OptumInsight is seeking an Operations Manager for the Commercial Data Mining team to drive ideation, establish operational standards, and optimize resource use. You will automate processes, improve efficiency, and build strong client relationships to support internal and external financial goals.

You’ll have the flexibility to work remotely from anywhere in the U.S., with Minneapolis/DC area staff needing in-office four days per week, and you will guide data workflows, audits, and reporting to

Qualifications

• 4+ years in healthcare, health insurance, payer operations, claims, payment integrity, or related experience
• 2+ years of experience with healthcare coding guidelines, reimbursement policies, and payment methodologies
• 2+ years of experience communicating with business stakeholders, clients, or leadership
• Proven understanding of healthcare claim adjudication and payer workflows
• Demonstrated understanding of EDI data, including 837 claim submission and 835 payment/remittance data
• Demonstrated ability to work independently and manage multiple priorities through completion

Responsibilities

• Ensure timely data acquisition and accuracy
• Maintain ideation pipeline
• Prioritize and manage audit production efficiency
• Drive timely recoveries
• Assist in strategic planning and budgeting
• Effectively communicate with, manage, and develop staff
• Provide reporting and attend meetings with internal and external stakeholders
• Support internal quality assurance efforts

Skills

Healthcare operations

Stakeholder communication

Process improvement

Project management

Job description

OptumInsight is improving the flow of health data and information to create a more connected system. We remove friction and drive alignment between care providers and payers, andultimately consumers. Our deepexpertisein the industry and innovative technology empower us to help organizations reduce costs while improving risk management,qualityand revenue growth. Ready to help us deliver results that improve lives? Join us in making healthcare work better for everyone through people-led, responsible AI while Caring. Connecting. Growing together. Commercial Data Mining focuses on analyzing industry trends, payment policies, contractual agreements, and processed claims data to identify incorrect provider payments made by health insurance payers. Advanced data analytics are developed to support audit activities, validating claim accuracy and payment processes to determine both the root cause and financial impact of overpayments. Our teams ensure recoveries are executed accurately and in a timely manner, delivering measurable value to our clients.

As an Operations Manager on the Commercial Data Mining team, you will drive strategic ideation, establish operational standards, and optimize resource utilization. This role focuses on automating business processes, improving operational efficiency, and building solid client relationships to support both internal performance objectives and external financial goals.

You’llenjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities

• Ensure timely data acquisition and accuracy
• Maintain ideation pipeline
• Prioritize and manage audit production efficiency
• Drive timely recoveries
• Assist in strategic planning and budgeting
• Effectively communicate with, manage, and develop staff
• Provide reporting and attend meetings with internal and external stakeholders
• Support internal quality assurance efforts

You’llbe rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well asprovidedevelopment for other roles you may be interested in.

Required Qualifications

• 4+ years of healthcare, health insurance, payer operations, claims, payment integrity, or related experience
• 2+ years of experience with healthcare coding guidelines, reimbursement policies, and payment methodologies
• 2+ years of experience communicating with business stakeholders, clients, or leadership
• Proven understanding of healthcare claim adjudication and payer workflows
• Demonstrated understanding of EDI data, including 837 claim submission and 835 payment/remittance data
• Demonstrated ability to work independently and manage multiple priorities through completion