Concept Validation & Ideation Analyst - Remote

Optum Insight 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, and ultimately consumers. Our deep expertise in the industry and innovative technology empower us to help organizations reduce costs while improving risk management, quality and 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.

The Concept Validation & Ideation Analyst is responsible for evaluating, validating, and advancing reimbursement policy and Shift Left opportunities that improve payment accuracy, affordability, provider experience, and operational efficiency. This role serves as a critical bridge between ideation and policy execution, ensuring concepts are fully researched, operationally viable, financially supported, and appropriately vetted before entering the policy development lifecycle.

The analyst partners with Shift Left, Payment Policy, Claims Operations, Analytics, CRD, PRD, and Affordability teams to assess opportunities originating from ideation forums, research tickets, operational findings, client discussions, and claim analysis. Through detailed research, policy review, impact analysis, and stakeholder collaboration, the analyst determines whether an opportunity warrants creation of a Payment Policy Ticket (PPT) ticket for a policy modification, enhancement, or new policy.

The position requires solid analytical, communication, facilitation, and presentation skills. The analyst develops business cases, leads concept discussions, presents recommendations to the client during preparation and design calls, incorporates feedback, and builds alignment before handing an approved concept to the Policy Creation team.

You'll enjoy 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

Shift Left Concept Validation

• Review and evaluate Shift Left concepts submitted to the Payment Policy ideation team
• Determine the policy, operational, financial, and implementation feasibility of each proposed concept
• Conduct root cause analysis and claims research to validate the opportunity and identify risks, dependencies, exclusions, and potential unintended impacts
• Assess medical cost savings potential, operational impact, scalability, and applicability across relevant lines of business
• Develop clear recommendations to advance, refine, redirect, or close a concept based on documented findings

Research Ticket Review & Broader Ideation

• Review research tickets, operational inquiries, and investigative findings to determine whether additional ideation is viable outside the Shift Left pipeline
• Identify reimbursement policy modification, clarification, enhancement, or new policy opportunities supported by the research findings
• Assess whether the opportunity has sufficient evidence and business rationale to create a PPT ticket for the Policy Creation team
• Identify recurring provider behaviors, coding patterns, reimbursement inconsistencies, claim trends, and operational pain points that may warrant policy intervention
• Collaborate with subject matter experts to address research gaps and strengthen viable policy opportunities

Concept Development & PPT Ticket Preparation

• Translate validated opportunities into clearly defined policy recommendations and business requirements
• Develop PPT tickets and supporting documentation for concepts advancing to the Policy Creation team
• Create savings estimates, impact analyses, concept summaries, presentation materials, and governance documentation
• Document the supporting evidence, policy rationale, client considerations, exclusions, operational impacts, assumptions, risks, and dependencies
• Ensure concepts are complete, decision-ready, and appropriately approved before handoff

Client Presentation & Stakeholder Engagement

• Prepare for and present concepts during client preparation and design calls
• Clearly explain the concept rationale, research findings, proposed policy change, anticipated financial value, operational considerations, and potential provider or member impacts
• Facilitate productive discussions, respond to questions, and address stakeholder concerns with confidence and credibility
• Incorporate client and stakeholder feedback into the concept and supporting documentation
• Build alignment and obtain the decisions needed before transitioning the concept to Policy Creation

Cross-Functional Collaboration & Handoff

• Partner with Payment Policy, Shift Left, CRD, PRD, Legal, Compliance, Claims Operations, Analytics, Technology, and Affordability teams
• Coordinate the reviews required to ensure concepts are policy-ready and operationally sound
• Communicate findings, recommendations, assumptions, risks, dependencies, decisions, and follow-up actions
• Provide a complete and organized handoff of approved concepts and PPT tickets to the Policy Creation team
• Remain available during the transition to clarify the original analysis, client decisions, and concept intent

Analytics, Tracking & Reporting

• Analyze claims, reimbursement data, operational metrics, policy information, and research findings to support decisions
• Maintain accurate tracking of concept status, review milestones, decisions, risks, and handoff dates
• Prepare concise, executive-ready summaries, presentations, and status updates
• Maintain audit-ready records of the research, validation, approvals, and supporting business rationale
• You'll be 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 as provide development for other roles you may be interested in.

Required Qualifications

• 3+ years of experience in healthcare operations, payment integrity, reimbursement policy, claims, affordability, analytics, consulting, or a related field
• Proven solid analytical, research, critical-thinking, and problem-solving skills
• Experience reviewing claims, policy, operational, clinical, or financial information and translating findings into actionable recommendations
• Experience with claim platforms UNET, USP, COSMOS, FACETS
• Proven solid written communication and documentation skills, including the ability to develop clear business cases, PPT tickets, and executive-ready materials
• Proven solid presentation and facilitation skills, including the ability to present complex recommendations to clients and cross-functional stakeholders
• Ability to respond to questions, explain assumptions and risks, and build alignment during preparation and design calls
• Proficiency with Excel, PowerPoint, and data analysis or reporting tools
• Ability to work independently, manage competing priorities, and collaborate effectively in a matrixed environment

Preferred Qualifications

Experience with Payment Policy, Payment Integrity, Claims Operations, Clinical Coding, Recovery Operations, or Affordability programs

Knowledge of reimbursement policy development, policy governance, claims adjudication, and payment accuracy concepts

Experience validating concepts, developing business cases, estimating financial value, or reviewing medical cost savings

Experience creating or reviewing policy change intake tickets and supporting documentation

Experience participating in client-facing preparation, design, governance, or recommendation meetings

Experience working with CRD, PRD, Shift Left, prevention, avoidance, or policy enhancement initiatives

*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 salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and help make the health system work better for everyone. Together, we are shaping the future of healthcare by harnessing technology and innovation to make care simpler to navigate, more affordable and more connected for the people we serve. We are committed to creating an inclusive workplace where everyone feels welcomed, valued, heard and respected, empowering people to bring their authentic selves to work and strengthening our collective impact through diverse talents, backgrounds, experiences and perspectives.

UnitedHealth Group and its affiliated brands are an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group and its affiliated brands are a drug-free workplace. Candidates are required to pass a drug test before beginning employment.