Senior Consultant Business Systems

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.

We are seeking a Senior Consultant - Business Systems (Salary Grade 28) to lead and deliver complex initiatives within Payment Integrity (PI) and Defensive AI. This role operates as a senior individual contributor and domain SME, driving end-to-end solutioning across business, data, and technology ecosystems.

You will play a critical role in shaping AI-driven detection strategies, claims integrity solutions, and enterprise system enhancements, ensuring measurable impact on cost savings, accuracy, and risk mitigation.

Primary Responsibilities:

• Strategic Business & AI Requirements Leadership
  • Lead end-to-end requirements lifecycle across complex, cross-functional initiatives
  • Translate business problems into advanced analytics, rule-based, and AI-driven solutions
  • Define solution scope, functional architecture, and non-functional requirements
  • Partner with product and engineering to influence solution feasibility and design decisions
• Defensive AI & Payment Integrity Solutioning
  • Design and enable FWA detection strategies, signals, and intelligence frameworks
  • Translate business scenarios into pre-pay/post-pay intervention logic and workflows
  • Partner with data science teams on model design inputs, feature definition, and validation frameworks
  • Identify systemic gaps and lead initiatives to improve detection accuracy and coverage
• End-to-End Solution Design & Delivery Ownership
  • Lead solution design across systems, data pipelines, and workflows
  • Ensure alignment with enterprise architecture, scalability, and integration standards
  • Drive Agile delivery execution, including backlog prioritization and solution validation
  • Act as a decision-maker for functional solution trade-offs and design choices
• Data Analysis, Insights & Value Realization
  • Perform advanced data analysis on claims, provider, and operational datasets
  • Translate insights into actionable recommendations and solution enhancements
  • Define and track business impact metrics (e.g., savings, detection rate, accuracy improvements)
• Stakeholder Leadership & Influence
  • Serve as a trusted advisor to business, product, and technology leaders
  • Lead workshops and strategic discussions to align on complex problems
  • Drive clear communication of risks, trade-offs, and strategic direction
• Process Innovation & Transformation
  • Lead initiatives for AI enablement, automation, and digitization
  • Drive shift-left strategies to improve early detection and reduce leakage
  • Identify opportunities to transform workflows using real-time decisioning and intelligent systems
• Mentorship & Capability Building
  • Provide guidance, mentorship, and quality oversight to junior analysts
  • Establish best practices in requirements, analysis, and solution design
  • Act as an escalation point for complex problem solving
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

• Bachelor's degree in Engineering, Technology, Business, or related field
• 6+ years of experience in Business Systems Analysis / Consulting roles
• Solid experience in:
  • Complex requirements and solution design
  • Data-driven analysis and system integration
  • Stakeholder management across senior audiences
• Proven ability to lead initiatives independently

Preferred Qualifications:

• Experience in Payment Integrity, Claims Processing, or Healthcare domain
• Experience with enterprise claims platforms, APIs, and cloud ecosystems
• Agile / Scrum experience (SAFe preferred)
• Exposure to AI/ML-driven use cases or analytics platforms
• Solid understanding of Fraud, Waste & Abuse (FWA) concepts
• Proficiency in SQL, data analysis, and reporting tools

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.