Medicaid SME Business Analyst - Remote

Requisition Number: 2352977
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.
The Medicaid SME Business Analyst plays a pivotal role in the successful implementation of an Enterprise Data Services (EDS) project by serving as the functional authority on Medicaid program operations and data. This role provides deep subject matter expertise across claims, recipient (eligibility), and provider domains, ensuring that business needs are accurately translated into scalable, high-quality data solutions. The analyst works closely with Agency program staff as well as Optum Data architects, ETL developers, QA teams, and Reporting/analytics partners. The role focuses on understanding how Medicaid programs operate end-to-end and ensuring that the data warehouse accurately represents program rules, workflows, and data relationships that support analytics, operations, oversight, and decision-making.
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:

• Serve as the Medicaid SME for core domains, including but noted limited to Claims and encounters, Recipient eligibility and enrollment, Provider enrollment and demographics
• Interpret Medicaid policy, program rules, and operational workflows and translate them into data and reporting requirements
• Develop and maintain key documentation such as Business Requirement Documents (BRDs), Functional Requirement Documents (FRDs), Data mapping and transformation specifications, Business rules and calculation logic etc.
• Define and document:
  • Source system dependencies (MMIS, Eligibility & Enrollment systems, Provider systems, MCO files)
  • End-to-end data flows from source to warehouse to analytics
  • Data quality and completeness expectations
• Validate requirements with program, operations, and policy stakeholders
• Decompose high level business requirements into detailed work breakdown structures, including user stories, use cases, and implementation tasks.
• Collaborate with technical teams to guide the database design aligned to Medicaid business needs and support downstream analytics and reporting
• Partner with ETL / ELT developers to review and validate Source-to-target mappings and transformation logic reflecting Medicaid business rules
• Partner with data governance teams to define data quality rules, thresholds, and monitoring metrics
• Support development of operational, analytic, and performance reporting use cases, such as Utilization and cost analysis, Recipient demographics and enrollment trends, Provider network and service delivery analysis etc.
• Ensure data warehouse outputs are usable, well-defined, and aligned with business expectations
• Provide SME input to Power BI developers, analysts, and data scientists on proper interpretation of Medicaid data
• Act as a key liaison between the different teams such as ETL, Reporting, Data Governance etc.
• Facilitate working sessions and design workshops to align on program rules and data usage
• Clearly communicate complex Medicaid concepts to technical audiences
• Proactively identify risks, dependencies, and gaps in requirements or data readiness
• Demonstrates accountability for understanding and aligning with the mission and goals of the role and department; consistently meets objectives while fostering a collaborative, engaged, and high performing team environment.
• Leverage enterprise-approved AI tools to streamline workflows, automate tasks, and drive continuous improvement

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:

• 5+ years of experience working with Medicaid programs, MMIS, or healthcare analytics
• 5+ years of experience in Medicaid Claims Processing or similar systems
• 5+ years of experience supporting Enterprise Data Warehouse or Large-scale data modernization initiatives
• 5+ years of experience with Microsoft office applications
• 3+ years of experience in SQL analyzing large healthcare datasets
• Willing to travel up to 25%

Preferred Qualifications:

• Experience working directly with state Medicaid agencies or Medicaid system vendors
• Experience working in Agile or hybrid delivery environments
• Experience working with Azure Dev Ops
• Knowledge of Medicaid Enterprise Systems (MES) and modular architectures

Key Skills & Competencies

• Medicaid domain expertise (claims, recipient, provider)
• Business analysis and requirements management
• Data analysis and validation
• Clear communication across technical and business audiences
• Attention to detail and analytical problem-solving
• Ability to translate operational workflows into data logic
• Collaborative and proactive mindset

*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 to $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 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.
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, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.