Associate Director, Payment Integrity Capability

Optum – Associate Director, Payment Integrity Capability

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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

About the Role

We have a key opportunity for an Associate Director, Payment Integrity Capability, based in Ireland. This is a hands-on leadership role in a fast-paced, high-value environment. The successful candidate will lead a varied portfolio of cross-functional initiatives and help shape how Payment Integrity identifies opportunities, tests solutions, scales proven practices and measures value.

The role is broader than traditional program coordination. It requires an agile, curious and outcomes-focused leader who can move between strategy, analysis and delivery; bring structure to ambiguous problems; and translate each initiative into clearly defined financial benefits or business KPI improvement. The candidate will work through a matrix of Operations, Business Reporting, Analytics, Finance, Procurement and Vendor Management, Transformation, Product and Technology partners, often without direct authority.

Careers with Optum offer flexible work arrangements and individuals who live and work in the Republic of Ireland will have the opportunity to split their monthly work hours between our Dublin or Letterkenny office and telecommuting from a home-based office in a hybrid work model.

Leadership Profile:

The successful candidate will be an agile, intellectually curious and commercially minded leader with a bias for action. They will be comfortable taking ownership before every detail is known, creating structure from ambiguity and working across several initiatives without losing sight of value. They will combine analytical rigor with pragmatic delivery, challenge weak assumptions constructively and build credibility through transparent measurement and follow-through.

Kay Responsibilities:

Capability Portfolio & Agile Delivery

• Lead multiple concurrent capability initiatives from opportunity framing through proof of concept, scale or closure, adapting the delivery approach to the size, uncertainty and risk of each initiative
• Translate strategic priorities and operational pain points into clear problem statements, hypotheses, outcomes, roadmaps, resource needs, dependencies and decision points
• Maintain a prioritized portfolio and delivery backlog; balance urgent business needs with longer-term capability building and make transparent trade-offs across scope, capacity and value
• Form and lead time-boxed, cross-functional teams for complex cross-PI opportunities; establish clear ownership, working rhythms and scale-or-drop criteria
• Operate comfortably across varied subject areas and take on new or unstructured work where ownership, process or solution is not yet defined

Value Definition, Business Cases & Benefits Realization

• Define the impact and benefit logic for every initiative, including financial outcomes such as cost reduction, cost avoidance, medical cost savings, productivity and growth, and non-financial outcomes such as quality, turnaround time, capacity, adoption, experience, risk and control effectiveness
• Develop business cases, benefit maps, baselines and measurement plans with Finance, Analytics and business owners; document assumptions, attribution, dependencies and potential dis-benefits
• Establish leading and lagging KPIs, targets and data sources before delivery begins; distinguish activity, output, operational outcome and realized enterprise value
• Own a concise value scorecard that gives leadership a live view of expected versus realized benefits, delivery confidence, risks and corrective actions
• Validate whether benefits are sustained after implementation and transition ongoing measurement and accountability to the appropriate business owner

Performance & Business Intelligence

• Partner with Business Reporting and Analytics to identify cross-PI outliers, value leakage, emerging risks and improvement opportunities
• Design signal-to-action triggers and early-warning measures that convert insights into accountable interventions, rather than creating reporting for reporting's sake
• Rationalize KPIs and improve metric definitions, data lineage and decision usefulness across operational and leadership reporting
• Use quantitative and qualitative analysis to diagnose root causes, test hypotheses and communicate a clear fact base for decisions

Operating Excellence & Replication

• Assess productivity, cycle time, CPH/AHT, manual effort and operator friction to identify material opportunities for simplification, standardization and automation
• Codify proven practices into reusable playbooks, controls, tools and operating standards, then lead replication across businesses, functions and locations
• Partner with Workforce Management and operational teams on capacity, demand and workforce models that support predictable execution and growth
• Ensure capability work improves how the business operates, not simply how activity is tracked or reported

Quality, Experience & Decision Excellence

• Support population-level assurance and risk- or confidence-based measurement approaches that extend beyond sample-based quality monitoring
• Help define governance and performance measures for human, rule-based and AI-enabled decisions, including accuracy, leakage, defect escape, overturn, adoption and feedback loops
• Connect quality improvement to provider and business experience, identifying opportunities to reduce rework, abrasion and avoidable handoffs
• Partner with Product, Technology, Analytics and Operations to embed learning loops and sustain improvements

Enterprise Economics & Strategic Levers

• Identify and structure opportunities across vendor economics, global location strategy, make-versus-buy decisions, capacity and growth shaping
• Partner with Finance, Procurement and Vendor Management to assess total economics, build credible value pipelines and track realized outcomes
• Evaluate options using financial, operational, quality, risk, talent and scalability considerations, and present clear recommendations and trade-offs
• Support business readiness and adoption for rightsourcing, globalization, technology and operating-model changes

Governance, Stakeholder Leadership & Communication

• Create simple, disciplined governance that accelerates decisions, manages dependencies and escalates impediments without adding unnecessary coordination
• Influence senior stakeholders and delivery partners without direct authority, build alignment across competing priorities and maintain accountability for outcomes
• Provide concise executive updates on value, progress, risks, decisions and leadership actions required
• Build trusted partnerships across Payment Integrity and adjacent enterprise teams; actively share knowledge so capability is transferred back into the business

You will 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 providing development for other roles you may be interested in.

Required Qualifications:

• Bachelor's degree in Business, Engineering, Healthcare Administration, Analytics, Finance, Strategy, Operations, or a related discipline, or equivalent practical experience
• Proven progressive experience leading business capability, transformation, operational excellence, strategy, consulting, or complex program portfolios within matrixed organizations
• Demonstrated ability to manage multiple concurrent initiatives, navigate ambiguity, and transition effectively between strategic planning, analysis, and execution
• Proven experience defining business impacts, developing business cases, and measuring financial and non-financial benefits in partnership with Finance and business stakeholders
• Demonstrated solid analytical capability, including identifying relevant data, challenging assumptions, establishing baselines, and translating analysis into actionable insights
• Proven experience designing KPIs, scorecards, or performance management frameworks that connect operational measures to business outcomes
• Demonstrated ability to influence without direct authority and align senior cross-functional stakeholders across Operations, Finance, Analytics, Product, and Technology functions
• Demonstrated solid executive communication, facilitation, problem-solving, and decision-support skills
• Demonstrated working knowledge of Lean, Six Sigma, Agile, change management, or comparable improvem