Payer Solutions Implementation Consultant - Remote

Requisition Number: 2374147
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 to start Caring. Connecting. Growing together.
With a focus on Optum Payer Implementations, the Payer Solutions Implementation Consultant is a hybrid, client facing role that bridges payer solutioning, implementation execution, and operational delivery at scale. This role serves as a trusted advisor to payer clients, ensuring Optum solutions are designed with deep payer domain expertise and delivered in a way that supports repeatable, multi payer operational outcomes.
The role requires a solid understanding of medical payer operations-including claims, eligibility, remittance, attachments, enrollment, network connectivity, regulatory requirements, and revenue integrity - within a multi payer ecosystem. The consultant plays a critical role in ensuring payer commitments translate into standardized, scalable, and supportable implementations that strengthen Optum's multi payer value proposition.
This role acts as a key integrator across Sales, Product, Engineering, Implementation, and Operations, aligning payer requirements to Optum platform capabilities and delivery standards to drive consistent execution, reduced risk, and faster time to value across multiple payer clients. Leading discovery discussions to identify payer problems, operational pain points, and strategic objectives, translating them into clear solution hypotheses aligned to Optum's broader portfolio.
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:

• Solution Consulting & Payer Advisory
  • Act as a payer subject matter expert, deeply understanding payer business models, operational workflows, regulatory constraints, and market pressures
  • Serve as a key pre sales partner to Sales and Growth teams, engaging early in the sales lifecycle to help lead client conversations, solution positioning, and deal strategy:
    • Understand payer objectives and pain points
    • Shape solution designs that align to payer operational realities
    • Ensure proposed solutions are implementable, scalable, and supportable
  • Translate payer requirements into clear solution architectures, implementation approaches, and delivery plans
  • Establish and reinforce solutioning standards to ensure proposed offerings are:
    • Aligned to Optum platform capabilities
    • Operationally feasible and scalable
    • Consistent across payer clients and markets
  • Provide consultative guidance on:
    • APIs include but are not limited to Claim Submission, Eligibility and Benefits, Prior Authorization, COB, attachments, Clearinghouse Connectivity, etc
    • Operational readiness, sequencing, and risk considerations
  • Serve as a trusted advisor to payer stakeholders, balancing client needs with product and platform capabilities
• Implementation Leadership & Delivery Execution
  • Own or co own the end to end implementation lifecycle for payer solutions, from kickoff through go live and transition to support
  • Lead complex payer implementations by:
    • Defining scope, milestones, dependencies, and success criteria
    • Driving requirements clarity and design validation
    • Anticipating and mitigating operational, technical, and regulatory risks
  • Partner closely with implementation, engineering, product teams to ensure alignment and execution discipline
  • Proactively manage implementation risks, issues, and dependencies across multiple teams
  • Ensure solutions are delivered in a way that supports long term operational stability, not just initial go live
• Cross Functional Collaboration
  • Act as the single connective role across:
    • Sales & Growth
    • Product Management
    • Engineering & Architecture
    • Implementation & Onboarding
    • Support & Operations
  • Ensure payer requirements are accurately represented across internal teams and not lost between sales handoff and delivery
  • Provide feedback loops to Product and Engineering based on payer insights, implementation challenges, and emerging needs
  • Influence roadmap discussions by bringing real world payer perspectives into solution and platform decisions
• Operational Excellence & Continuous Improvement
  • Identify recurring payer implementation challenges and drive improvements in:
    • Standardization
    • Tooling
    • Playbooks
    • Delivery assurance criteria
  • Help reduce friction, rework, and cycle time by improving upfront solution design and readiness
  • Contribute to the development of best practices, templates, and implementation standards for payer solutions
  • Support training and enablement of sales, implementation, and support teams on payer specific solutioning and delivery considerations

Key Competencies & Skills

• Domain Expertise
  • Deep understanding of medical payer operations, including:
    • Claims (professional & institutional)
    • ERA / remittance
    • Eligibility
    • Attachments
    • Enrollment and connectivity
    • Revenue cycle and payment integrity
  • Solid familiarity with payer regulatory and compliance considerations
  • Ability to anticipate payer concerns and operational constraints before they surface
  • Consultative & Communication Skills
  • Executive level communication skills with the ability to explain complex concepts clearly and confidently
  • Solid consultative presence; able to influence without authority
  • Ability to balance client advocacy with internal feasibility and platform constraints
• Delivery & Execution Strength
  • Proven experience leading or influencing complex implementations
  • Solid organizational, prioritization, and risk management skills
  • Comfortable operating in ambiguous environments where requirements evolve

Success Measures
Success in this role is measured by:

• Payer solutions that are well designed upfront and successfully implemented with minimal rework
• Reduced implementation risk, cycle time, and post go live issues
• Solid payer satisfaction and trust
• Improved alignment between sales commitments, product capabilities, and delivery outcomes
• Clear contribution to scalable, repeatable payer solution models

Ideal Candidate Profile

• Background in payer operations, healthcare technology, clearinghouse, or network solutions
• Experience in solution consulting, implementation leadership, or technical program management within healthcare
• Solid understanding of how payer decisions impact downstream operations and customer experience
• Comfortable operating at both strategic and execution levels

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:

• 4+ years of Payer / Healthcare Domain Expertise (Core Requirement)
  • Experience with clearinghouse, network connectivity, or revenue cycle ecosystems
  • Medical payer operations (claims, eligibility, remittance, enrollment, etc.)
  • Exposure to regulatory/compliance environments
  • Hands-on understanding of payer environments solidly preferred
• 3+ years of Implementation / Delivery Leadership
  • Leading or co-leading end-to-end implementations
  • Managing scope, milestones, dependencies, and risk
  • Cross-functional coordination across Product, Engineering, Ops
  • Experience reducing cycle time, rework, and post-go-live issues
• 2+ years of Solution Consulting / Client-Facing Experience
  • Pre-sales support, solution design, and client advisory
  • Translating business needs into scalable solutions
  • Executive-level communication and stakeholder influence
  • Ability to travel up to 25% when required

Preferred Qualifications:

• 1+ years of Technical / Platform / API Exposure
  • Familiarity with APIs (claims, eligibility, prior auth, attachments)
  • Understanding of system integrations, data exchange, or platform-based solutions
  • Experience working with engineering/product teams on solution delivery

*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 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.