Director of Claims Pricing Solutions - Remote

Primary Responsibilities

• Collaborating with internal cross-functional teams, including internal market, growth, operations, and product teams; and external business partners to support growth and renewal strategies for Optum's Payment claims pricing software and services portfolio
• Developing and presenting client-specific presentations, software solutions, managing stakeholders through the contract lifecycle, and ensuring proposals include the correct solution mix, pricing approach, contract terms, and value story
• Providing voice-of-customer feedback, reviewing new solution concepts, identifying target customers, and helping launch new products to the market
• Presenting Optum's full pricing software capabilities
• Applying advanced analytical and quantitative approaches to problem-solving for large complex clients with multiple lines of business and/or products and/or new-to-market solutions
• Using communication skills to influence and negotiate
• Working directly with customers to define other new pricing needs and requirements
• Supporting Optum Business Partners with questions around integration
• Compiling documentation: processes and procedures (including but not limited to client or system-specific tracking)
• Prioritizing projects and outcomes identified by the Executive Team
• Providing insight related to savings targets, budget and forecasting, and increased medical and administrative savings opportunities
• Driving execution on new sales opportunities and developing new pricing models for emerging products and content, including sales presentations, RFP responses, and providing expertise in pricing new deals and renewals as well as more complex vendor and tri-party agreements
• Ensuring that contracts are reviewed and represent the best interest of the business

Required Qualifications

• 8+ years of claims pricing experience
• Experience translating, configuring, and testing pricing terms into a contract management software tool
• Experience with facility and professional contracting and reimbursement across Medicare, Medicaid, and Commercial
• Health plan experience in facility contract configuration, claims, network contracting or a technology division
• Claims system and/or contract modeling experience with at least of one of the following: Cognizant: Facets/NetworX, QNXT/NetworX; HealthEdge: Health Rules Payer; Advantasure: iKA Claims; Epic: Tapestry; 3M: GPCS; RAM: HealthSuite; and/or Conduent/HSP: MediTrac; HealthEdge Source; Zelis: Payer Compass; Reimbursement Manager (REM); PMMC: Contract Modeling; Strata: Market Reimbursement Intelligence or Contract Analytics; MD Clarity: RevFind or Clarity Flow; ClaraPrice: Payer Contract Management
• Proven excellent verbal and written communication skills. Ability to influence and negotiate effectively

Preferred Qualifications

• 10+ years of claims pricing experience
• Experience using Optum pricing tools: Rate Manager, Payment System Interface, and/Reimbursement Manager
• Experience documenting client operational, pricing, and technical workflows
• Account management experience
• Project management experience
• Proven experience in leading cross-functional teams and managing large-scale projects
• Knowledge of emerging trends and technologies (AI) in healthcare
• Understanding of healthcare industry regulations and compliance requirements
• Proven track record in managing executive initiatives and driving strategic projects