Optum Logo

Optum

Director, Enterprise Fraud Platforms & Capabilities - Remote

Posted An Hour Ago
Be an Early Applicant
In-Office or Remote
Hiring Remotely in Eden Prairie, MN
135K-231K Annually
Expert/Leader
In-Office or Remote
Hiring Remotely in Eden Prairie, MN
135K-231K Annually
Expert/Leader
Lead enterprise fraud platform strategy and delivery for Directed Spend and Commercial Payments. Define capabilities, prioritize investments, translate risk and regulatory requirements into requirements, ensure control readiness, drive adoption, measure outcomes, and coordinate cross-functional governance with Product, Technology, Data Science, Operations, and second-line partners.
The summary above was generated by AI
Requisition Number: 2377239
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.
Optum Financial protects customers and the business by preventing, detecting, and responding to fraud. We are seeking a senior strategic leader to direct fraud platforms and capabilities for the Directed Spend and Commercial Payments Fraud Operations programs. This role defines fraud capability needs, shapes investment priorities, and translates fraud risk, policy, governance, and operational needs into clear requirements, prioritization recommendations, delivery readiness, and measurable outcomes. The role partners closely with centralized Product and Technology teams to ensure solutions are scalable, defensible, operationally durable, and usable by Fraud Operations and other first-line teams. It also supports these solutions through enterprise roadmap, capital planning, change control, and release processes.
You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.
Primary Responsibilities:
  • Define fraud platform and capability needs for Directed Spend and Commercial Payments Fraud Operations. Translate fraud strategy, standards, and roadmap priorities into executable plans aligned with risk appetite, regulatory requirements, business objectives, and governance expectations
  • Lead cross-functional alignment with enterprise partners on priority threats, required capabilities, delivery sequencing, approval decisions, and escalation expectations
  • Establish performance baselines, set targets, and drive measurable improvement across fraud losses, detection quality, response speed, operational efficiency, control effectiveness, and customer experience through platform and capability enhancements
  • Ensure platform design considers fraud agent usability and operational experience, including workflows, alerts, queues, case views, and reporting outputs that support efficient investigation, consistent decisioning, quality control, and frontline adoption
  • Ensure fraud decisioning, alerting, monitoring, case management, systems, and tools integrate effectively into operating workflows, procedures, training materials, reporting routines, oversight processes, and evidence repositories
  • Lead fraud control readiness reviews for new or modified solutions. Ensure controls, monitoring, procedures, testing evidence, documentation, launch criteria, and post-launch ownership expectations are complete before deployment
  • Direct requirements definition, prioritization recommendations, implementation support, adoption planning, and launch preparation from pilot through rollout and ongoing performance measurement
  • Partner with Technology, Data Science, Product, Fraud Operations, Procurement, and business leaders to define fraud capability priorities, align delivery plans, resolve dependencies, and support disciplined implementation tradeoffs
  • Coordinate governance routines, approval pathways, and escalation mechanisms with cross-functional and second-line partners. Ensure decision inputs, risks, dependencies, and ownership expectations are clearly documented
  • Represent platform and capability readiness in second-line assessments. Provide evidence and walkthroughs, respond to credible challenge, and drive actions, issues, and remediation commitments to closure
  • Maintain KPI scorecards, KRIs where applicable, and operating review materials using enterprise definitions and reporting standards to track progress, elevate decisions, and support governance routines

Decision Rights and Ways of Working:
  • Owns: Fraud platform and capability needs, execution plans, requirements, prioritization recommendations, delivery readiness inputs, KPI/KRI operationalization, readiness assessments, adoption support, and performance measurement for assigned solutions
  • Partners: Product, Technology, Data Science, Directed Spend and Commercial Payments Fraud Operations, Procurement as applicable, Compliance, Legal, Risk, Privacy, business leaders, and the independent second-line Fraud Risk Assessment Program
  • Influences: Platform priorities, investment decisions, delivery sequencing, capability requirements, vendor direction, and governance outcomes through documented requirements, business cases, impact sizing, risk assessment, readiness inputs, and decision recommendations

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:
  • Bachelor's degree in Business, Finance, Computer Science, Engineering, or a related field
  • 10+ years of progressive leadership experience in fraud, payments, risk, financial services, operations, platform management, or technology delivery, including ownership of enterprise-scale capabilities and cross-functional initiatives
  • 5+ years leading fraud or risk platform programs, delivering measurable outcomes in fraud loss reduction, operational efficiency, customer experience, and regulatory compliance
  • 5+ years implementing or enhancing fraud technologies, including decision engines, case management platforms, monitoring tools, alerting frameworks, and performance measurement solutions
  • 5+ years leading control readiness, governance, or oversight activities for new or enhanced capabilities, including change management, testing oversight, monitoring controls, release approvals, evidence documentation, and post-implementation performance reviews
  • 3+ years partnering with analytics and data science teams to support model governance, performance monitoring, testing, and controlled production deployments
  • Proven ability to influence and align executive stakeholders across business, product, technology, operations, risk, compliance, and governance functions
  • Experience translating business, policy, regulatory, and risk requirements into scalable platform capabilities, operational controls, and measurable outcomes
  • Demonstrated expertise in fraud risk management across payments fraud, account takeover, identity fraud, servicing fraud, controls governance, and issue remediation within a regulated financial environment
  • Demonstrated success managing regulatory findings, issue remediation, and corrective action plans in partnership with Compliance, Legal, Risk, Audit, and other second-line functions

Preferred Qualifications:
  • Master's degree or relevant industry certifications
  • Experience with healthcare payments, directed spend products, commercial payments, benefits administration, or adjacent domains with complex fraud and risk considerations
  • Hands-on experience with fraud decisioning, case management, real-time rules, monitoring, identity controls, and account takeover controls
  • Experience operating within enterprise delivery, capital planning, or scaled agile environments.
  • Proven solid communication and influence skills, including the ability to frame complex tradeoffs, secure alignment, and support clear decision-making across business, product, technology, operations, risk, and governance partners

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy.
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $134,600 to $230,800 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
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.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

Similar Jobs at Optum

An Hour Ago
In-Office or Remote
92K-164K Annually
Senior level
92K-164K Annually
Senior level
Artificial Intelligence • Big Data • Healthtech • Information Technology • Machine Learning • Software • Analytics
Serve as primary liaison between OptumRx and Health Plan clients, leading cross-functional teams to meet contractual obligations, resolve complex PBM issues, ensure data integrity, support implementations, coordinate member outreach, and drive client retention and growth while partnering with Analytics, Regulatory, and operational teams.
Top Skills: Claims Adjudication PlatformsExcelOutlookPowerPointRxclaimTeamsWord
An Hour Ago
In-Office or Remote
92K-164K Annually
Senior level
92K-164K Annually
Senior level
Artificial Intelligence • Big Data • Healthtech • Information Technology • Machine Learning • Software • Analytics
Lead design and implementation of operating models, processes, and governance to ensure Medicaid regulatory adherence for pharmacy network operations. Manage regulatory intake, impact assessment, solution design, implementation, monitoring, stakeholder alignment, executive reporting, and support for audits and state escalations across cross-functional teams.
Top Skills: ExcelMicrosoft PowerpointMicrosoft Word
An Hour Ago
In-Office or Remote
73K-130K Annually
Junior
73K-130K Annually
Junior
Artificial Intelligence • Big Data • Healthtech • Information Technology • Machine Learning • Software • Analytics
Perform PBM network pricing and financial modeling to support pricing strategy, contract valuation, client guarantees, and operational decisions. Analyze claims, pricing, contract, and utilization data to produce insights and executive-ready recommendations. Partner with analytics, operations, and technology teams to improve pricing tools, data products, workflows, and governance. Support Agile delivery, prioritize requirements, test enhancements, identify risks and anomalies, and drive adoption of process improvements and automation to scale pricing operations.

What you need to know about the Colorado Tech Scene

With a business-friendly climate and research universities like CU Boulder and Colorado State, Colorado has made a name for itself as a startup ecosystem. The state boasts a skilled workforce and high quality of life thanks to its affordable housing, vibrant cultural scene and unparalleled opportunities for outdoor recreation. Colorado is also home to the National Renewable Energy Laboratory, helping cement its status as a hub for renewable energy innovation.

Key Facts About Colorado Tech

  • Number of Tech Workers: 260,000; 8.5% of overall workforce (2024 CompTIA survey)
  • Major Tech Employers: Lockheed Martin, Century Link, Comcast, BAE Systems, Level 3
  • Key Industries: Software, artificial intelligence, aerospace, e-commerce, fintech, healthtech
  • Funding Landscape: $4.9 billion in VC funding in 2024 (Pitchbook)
  • Notable Investors: Access Venture Partners, Ridgeline Ventures, Techstars, Blackhorn Ventures
  • Research Centers and Universities: Colorado School of Mines, University of Colorado Boulder, University of Denver, Colorado State University, Mesa Laboratory, Space Science Institute, National Center for Atmospheric Research, National Renewable Energy Laboratory, Gottlieb Institute

Sign up now Access later

Create Free Account

Please log in or sign up to report this job.

Create Free Account