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 advantages, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers, comprehensive perks 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

• Golden Dataset & Claim Scenario Creation
• Generate test claims as a Payer and Adjudication Subject Matter Expert to support agentic AI solution evaluations, both for internal support functions and governance (Agent Evaluation Systems, AIRB, etc.)
• Generate files to simulate and support Payer Operations AI solutions (advantage, pricing, etc), both for internal support and governance
• Identify or construct representative claim scenarios aligned to business and product requirements,



then de-identify and modify data as needed
• Translate product requirements into scalable testing files covering both core functionality and edge cases

• Adjudication & Outcome Determination
• Manually apply benefit and adjudication rules to create expected outcomes aligned with the scope and data sources of each agentic solution
• Validation of simulated payer files
• Determine allow/reject determinations with clearly supporting rationale, and calculate financial impacts and member responsibility
• Ensure citation and traceability of determination logic so outcomes can be defended in review

• Structured Output Generation & QA
• Create structured outputs - X12, JSON, Excel, and answer keys - to support agent testing and evaluation
• Perform quality assurance on generated files and outcomes to ensure accuracy and consistency

• Model Testing, Evaluation & Governance Support
• Provide di

📌 Senior Business Analyst Consultant Hyderabad
🏢 Optum India
📍 Hyderabad