Experience
5 - 10 yrs
Job Location
Noida, India
Vacancy
1
Designation
Data Analyst
Job Type
ONSITE
Job Description
The Senior Data Analyst UHC Claims Platforms is a domain focused analytics role responsible for analyzing, validating, and interpreting healthcare claims data across UnitedHealthcare claims platforms such as UNET, COSMOS, CSP, and Facets
This role acts as a bridge between claims operations, analytics, and automation teams, ensuring that analytical outputs, dashboards, validation datasets, and AI models are grounded in real world claims processing logic and policy intent
This role is critical in initiatives related to claims automation, first pass adjudication, rework reduction, quality improvement, and AI driven decisioning
Key Responsibilities
Claims Domain Analytics
Perform deep dive analysis of medical and behavioral health claims data across UNET and COSMOS platforms
Understand and interpret end to end claims lifecycle, including intake, edits, pends, denials, adjustments, rework, and final adjudication
Analyze claim outcomes in relation to benefit configuration, policy rules, provider contracts, and member eligibility
Support analysis for first pass claims, auto adjudication, rework scenarios, and appeals
Data Validation & SME Enablement
Validate datasets used for analytics, dashboards, and AI/ML model training against actual platform behavior
Identify gaps between policy intent and system execution by analyzing claim outcomes across platforms
Act as a claims SME for analytics, data science, and engineering teams, ensuring correct interpretation of UNET/COSMOS data elements
Support UAT and pilot evaluations for claims automation and AI initiatives by validating decision logic and outputs
Analytics & Reporting
Build and maintain analytical datasets, metrics, and dashboards related to claims volume, quality, turnaround time, and auto adjudication performance
Analyze trends and patterns in claims data to identify leakage, quality issues, and automation opportunities
Support leadership reporting with accurate, explainable, and audit ready analytics derived from claims platforms
Cross Functional Collaboration
Partner with Claims Operations, Product Owners, and Policy SMEs to translate operational processes into analytics requirements
Work closely with Data Engineers and ML Engineers to ensure claims data is correctly sourced, transformed, and interpreted
Participate in backlog refinement, requirements discussions, and solution reviews for claims automation programs
Required Domain Experience
Strong hands on experience with UHC Claims platforms, specifically:
UNET (claim processing, ARU/EAS logic, rework, adjustments)
COSMOS (first pass claims, facility claims, claim edits)
Solid understanding of:
Claims edits, pends, denials, and rework flows
Benefit application and policy logic
Provider and member data relationships
Experience working with claims related reference systems such as CSP, Facets, NDB, or CORE is highly desirable
Technical & Analytical Skills
Strong SQL skills for querying large claims datasets
Experience working with enterprise data warehouses or analytics platforms
Ability to analyze complex datasets and translate findings into clear business insights
Working knowledge of Excel and BI tools for analysis and reporting
Familiarity with validation datasets used for AI/ML initiatives is a plus
This role acts as a bridge between claims operations, analytics, and automation teams, ensuring that analytical outputs, dashboards, validation datasets, and AI models are grounded in real world claims processing logic and policy intent
This role is critical in initiatives related to claims automation, first pass adjudication, rework reduction, quality improvement, and AI driven decisioning
Key Responsibilities
Claims Domain Analytics
Perform deep dive analysis of medical and behavioral health claims data across UNET and COSMOS platforms
Understand and interpret end to end claims lifecycle, including intake, edits, pends, denials, adjustments, rework, and final adjudication
Analyze claim outcomes in relation to benefit configuration, policy rules, provider contracts, and member eligibility
Support analysis for first pass claims, auto adjudication, rework scenarios, and appeals
Data Validation & SME Enablement
Validate datasets used for analytics, dashboards, and AI/ML model training against actual platform behavior
Identify gaps between policy intent and system execution by analyzing claim outcomes across platforms
Act as a claims SME for analytics, data science, and engineering teams, ensuring correct interpretation of UNET/COSMOS data elements
Support UAT and pilot evaluations for claims automation and AI initiatives by validating decision logic and outputs
Analytics & Reporting
Build and maintain analytical datasets, metrics, and dashboards related to claims volume, quality, turnaround time, and auto adjudication performance
Analyze trends and patterns in claims data to identify leakage, quality issues, and automation opportunities
Support leadership reporting with accurate, explainable, and audit ready analytics derived from claims platforms
Cross Functional Collaboration
Partner with Claims Operations, Product Owners, and Policy SMEs to translate operational processes into analytics requirements
Work closely with Data Engineers and ML Engineers to ensure claims data is correctly sourced, transformed, and interpreted
Participate in backlog refinement, requirements discussions, and solution reviews for claims automation programs
Required Domain Experience
Strong hands on experience with UHC Claims platforms, specifically:
UNET (claim processing, ARU/EAS logic, rework, adjustments)
COSMOS (first pass claims, facility claims, claim edits)
Solid understanding of:
Claims edits, pends, denials, and rework flows
Benefit application and policy logic
Provider and member data relationships
Experience working with claims related reference systems such as CSP, Facets, NDB, or CORE is highly desirable
Technical & Analytical Skills
Strong SQL skills for querying large claims datasets
Experience working with enterprise data warehouses or analytics platforms
Ability to analyze complex datasets and translate findings into clear business insights
Working knowledge of Excel and BI tools for analysis and reporting
Familiarity with validation datasets used for AI/ML initiatives is a plus
Qualifications
Bachelor s degree or equivalent practical experience
5+ years of experience in data analysis roles within healthcare or insurance domains
Demonstrated experience analyzing medical or behavioral health claims data within UHC env
Strong comm skills with the ability to explain complex claims logic to technical and non technical stakeholders
Success Measures
Analytics and validation datasets accurately reflect real claims processing behavior
Claims automation and AI initiatives are supported by high quality, domain validated data
Reduction in defects caused by misinterpretation of claims data
Increased trust from claims operations & leadership in analytics outputs
Bachelor s degree or equivalent practical experience
5+ years of experience in data analysis roles within healthcare or insurance domains
Demonstrated experience analyzing medical or behavioral health claims data within UHC env
Strong comm skills with the ability to explain complex claims logic to technical and non technical stakeholders
Success Measures
Analytics and validation datasets accurately reflect real claims processing behavior
Claims automation and AI initiatives are supported by high quality, domain validated data
Reduction in defects caused by misinterpretation of claims data
Increased trust from claims operations & leadership in analytics outputs
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