Job Description

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.

Primary Responsibilities:

• Design, develop, and implement AI/ML and Generative AI solutions supporting Core Claims initiatives including Duplicate Overpayments, Fraud, Waste & Abuse (FWA) Disputes, and First Pass Claims
• Develop and deploy Large Language Model (LLM) powered applications, prompt engineering solutions, and Retrieval-Augmented Generation (RAG) frameworks
• Apply AI techniques to automate claims workflows including classification, intelligent routing, document understanding, decision support, and operational triage
• Collaborate with engineering, product, analytics, and business teams to build scalable AI solutions that address complex business challenges
• Develop frameworks for model evaluation, performance testing, validation, and continuous improvement
• Partner with data science and engineering teams on feature engineering, model deployment, inference optimization, and production support
• Ensure adherence to Responsible AI practices, including explainability, governance, fairness, and model validation standards
• Identify opportunities to improve operational efficiency through AI-driven automation and intelligent decision-making
• Stay current with advancements in Artificial Intelligence, Generative AI, Large Language Models, and related technologies
• Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

• Bachelor's or Master's degree in Computer Science, Artificial Intelligence, Machine Learning, Data Science, or a related field
• 7+ years of experience in AI/ML solution development, with hands-on experience in Generative AI and Large Language Models (LLMs)
• Experience building and deploying LLM-powered applications, RAG architectures, prompt engineering solutions, and intelligent automation systems
• Experience with model evaluation frameworks, performance optimization, and AI solution validation
• Experience collaborating with cross-functional teams across engineering, analytics, product management, and business functions
• Understanding of Responsible AI principles, model explainability, governance, and ethical AI practices
• Solid proficiency in Python and modern AI/ML frameworks and toolchains
• Proven problem-solving, communication, stakeholder management, and presentation skills

Preferred Qualifications:

• Experience within healthcare, healthcare claims, payment integrity, fraud detection, or operational analytics domains
• Experience with cloud-based AI/ML platforms and MLOps practices
• Experience delivering AI solutions that drive measurable business outcomes and operational efficiencies
• Knowledge of Medicare & Retirement (M&R) Claims processes and operations

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.