Optum ยท 1 month ago
EDW Medicaid Subject Matter Expert or Data Specialist - Remote
United States
Full-time
Remote
Senior Level, Lead/Staff
$110K/yr - $189K/yr
10+ years expOptum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The role of Medicaid Subject Matter Expert involves providing guidance and direction for large data warehouse implementations and operations, ensuring compliance with Medicaid requirements and enhancing data processes.
EducationHealth CareMedicalPharmaceutical
Responsibilities
Provide direction, guidance and recommendations supporting decision making for large Medicaid data warehouse implementation and operations
With the specialized knowledge of the Medicaid and Children's Health Insurance Programs (CHIP), lead and guide internal and external stakeholders to make determinations relating to complex processes involving claims processing/adjudication, recipient eligibility, provider enrollment, and third-party liability
Proactively identify and understand state Medicaid agency data needs and determines the recommended solution to meet them with credible reason, justification and validated proof of concepts
Direct technical and business teams on healthcare topics understanding and utilizing healthcare data appropriately
Proactively suggest and recommend enhancements and improvements throughout the project processes, driven by Medicaid best practices, standards and policies
Qualification
Required
10+ years of experience in information technology with 5+ years of experience working directly with/for State Medicaid agencies or equivalent supporting business initiatives through data analysis, writing business requirements and testing/validation of various systems
2+ years of experience working CMS Federal Reporting MARS, PERM, T-MSIS, Quality of Care CMS Core Measure or similar projects
Knowledge of the Centers for Medicare and Medicaid Services reporting requirements and the programs covered
Understanding of claims, recipient/eligibility, and provider/enrollment data processes
Proven ability to create and perform data analysis using SQL, Excel against data warehouses utilizing large datasets
Proven excellent verbal/written communication and presentation skills, manager/executive/director-level client facing, team collaboration, and mentoring skills
Proven solid culture fit, demonstrating our culture values in action (Integrity, Compassion, Inclusion, Relationships, Innovation, and Performance)
Ability to travel to Springfield, IL two (3) to three (4) times per year or as needed
Preferred
2+ years of experience in HEDIS, CHIPRA or similar quality metrics
Experience with data analysis using Teradata Database Management System or other equivalent database management system
Experience using JIRA, Rally, DevOps or equivalent
Experience in large implementation or DDI project
Located within driving distance (3 - 5 Hours) of Springfield, IL
All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Benefits
Comprehensive benefits package
Incentive and recognition programs
Equity stock purchase
401k contribution
Company
Optum
Optum is a healthcare company that provides pharmacy services, health care operations, and population health management. It is a sub-organization of UnitedHealth Group.
10001+ employees
H1B Sponsorship
Optum has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (648)
2024 (559)
2023 (620)
2022 (851)
2021 (593)
2020 (438)
Funding
Current Stage
Late StageLeadership Team
Daniel Castillo
Chief Executive Officer, Optum Care Delivery
J
Jay Green
Chief Financial Officer
Recent News
2025-11-29
2025-11-19
2025-11-07
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