Business Analyst Consultant- Sacramento, CA
Optum, Sacramento, CA, United States
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do will directly improve health outcomes by connecting individuals 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.
Key Responsibilities
Prevent and identify potential healthcare fraud, waste and abuse (FWA) using complex algorithms, a Fraud and Abuse Detection System (FADS), and Cognos-based fraud detection system, and analytical tools such as BusinessObjects, Power BI, SQL, or SAS.
Creating and/or assisting with algorithm ideation to support and conduct data mining to detect fraudulent, wasteful, or abusive provider patterns within the Medi Cal program.
Prepare and present well documented, clearly summarized case findings to DHCS and A&I staff for potential case acceptance.
Provide analytical and reporting support for ongoing fraud and abuse investigations.
Review and provide feedback on case summaries and reports developed by team members.
Deliver focused, on‑site consultation to program areas related to fraud and abuse.
Recommend enhancements to FADS that improve efficiency, data retrieval, interpretation, and presentation.
Analyze, forecast, trend, and interpret complex healthcare data to support operational and business planning.
Present analytical insights to stakeholders for decision making and strategic review.
Experience in Medicare or private insurance program integrity will also be considered.
Demonstrated expertise in healthcare data analysis and fraud detection methodologies.
Excellent written, verbal, and presentation skills.
Required Qualifications
3 years of experience in Medi Cal (Medicaid) and/or Managed Care, with a strong focus on program integrity.
2 years of experience using BusinessObjects.
Knowledge of Microsoft Office Suite.
Preferred Qualifications
Experience using Power BI, SQL, SAS and Power BI.
Bachelor's degree in healthcare or a related field.
Work Location
Hybrid position: Currently one day per week onsite in Sacramento, CA.
Please note: The position is contractually designated as onsite, and office requirements may increase up to daily attendance based on business needs.
Compensation and Benefits The salary for this role will range from $91,700 to $163,700 annually based on full‑time employment. Pay is based on factors such as local labor markets, education, work experience, certifications, and more. In addition to your salary, we offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401(k) contributions (all benefits are subject to eligibility requirements). We comply with all minimum wage laws as applicable.
Drug‑Free Workplace UnitedHealth Group is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.
Equal Employment Opportunity UnitedHealth Group is 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, protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
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Key Responsibilities
Prevent and identify potential healthcare fraud, waste and abuse (FWA) using complex algorithms, a Fraud and Abuse Detection System (FADS), and Cognos-based fraud detection system, and analytical tools such as BusinessObjects, Power BI, SQL, or SAS.
Creating and/or assisting with algorithm ideation to support and conduct data mining to detect fraudulent, wasteful, or abusive provider patterns within the Medi Cal program.
Prepare and present well documented, clearly summarized case findings to DHCS and A&I staff for potential case acceptance.
Provide analytical and reporting support for ongoing fraud and abuse investigations.
Review and provide feedback on case summaries and reports developed by team members.
Deliver focused, on‑site consultation to program areas related to fraud and abuse.
Recommend enhancements to FADS that improve efficiency, data retrieval, interpretation, and presentation.
Analyze, forecast, trend, and interpret complex healthcare data to support operational and business planning.
Present analytical insights to stakeholders for decision making and strategic review.
Experience in Medicare or private insurance program integrity will also be considered.
Demonstrated expertise in healthcare data analysis and fraud detection methodologies.
Excellent written, verbal, and presentation skills.
Required Qualifications
3 years of experience in Medi Cal (Medicaid) and/or Managed Care, with a strong focus on program integrity.
2 years of experience using BusinessObjects.
Knowledge of Microsoft Office Suite.
Preferred Qualifications
Experience using Power BI, SQL, SAS and Power BI.
Bachelor's degree in healthcare or a related field.
Work Location
Hybrid position: Currently one day per week onsite in Sacramento, CA.
Please note: The position is contractually designated as onsite, and office requirements may increase up to daily attendance based on business needs.
Compensation and Benefits The salary for this role will range from $91,700 to $163,700 annually based on full‑time employment. Pay is based on factors such as local labor markets, education, work experience, certifications, and more. In addition to your salary, we offer a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401(k) contributions (all benefits are subject to eligibility requirements). We comply with all minimum wage laws as applicable.
Drug‑Free Workplace UnitedHealth Group is a drug‑free workplace. Candidates are required to pass a drug test before beginning employment.
Equal Employment Opportunity UnitedHealth Group is 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, protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
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