Optum Solutions for the Public Sector
- SGS AI Capabilities: A reusable, responsible AI capability foundation embedded across Optum State Government solutions that helps teams understand documents, support members, providers and staff, identify risk, review evidence and accelerate service delivery. Capabilities include document intelligence, language access, call intelligence, provider and prior authorization workflow support, program integrity intelligence, audit support, forms automation and delivery productivity accelerators—all designed to augment human decision-making with transparency and operational control.
- Rural Health Transformation Solutions: A combination of advisory services, advanced analytics and enabling technology that helps states address rural health priorities such as telehealth expansion, digital health and infrastructure modernization, value-based care, social drivers of health, maternal and behavioral health, and workforce development.
- Optum Program Integrity: A comprehensive, AI-enabled program integrity solution that supports state Medicaid agencies across the claims lifecycle—spanning pre-adjudication, pre-pay and post-pay capabilities. It helps states prevent improper payments, identify high-risk claims prior to payment and detect potential fraud, waste and abuse post-payment, with flexible deployment aligned to state priorities and operational maturity.
- Optum Health Care Performance Analytics: A comprehensive analytics solution that helps agencies improve program performance, support financial stewardship and strengthen population health through intuitive reporting, connected insights and predictive models.
- Optum Rapid Insights as a Service: A rapid-deployment analytics offering for Medicaid agencies that delivers out-of-the-box insights—including population risk, chronic conditions and social drivers—in as little as one month to help accelerate data-informed decision-making.
- Optum State and Federal Reporting: A CMS-aligned reporting solution that helps states produce required federal reports and T-MSIS extracts, improve data quality and strengthen transparency through robust validation, documentation and drill-down reporting.
- Optum State Data Hub: A scalable, cloud-enabled data platform designed for state government that supports secure data integration, interoperability, governance and advanced analytics across programs and systems.
- Optum Provider Management Services: A configurable provider lifecycle management solution that supports enrollment, credentialing, revalidation and ongoing maintenance—improving provider experience while strengthening program compliance and oversight.
- Optum LTSS: A technology-enabled solution for long-term services and supports that brings together assessment, service authorization, program integrity, provider engagement, reporting and contact center capabilities to support coordinated, person-centered care and program oversight.
- Independent Assessment: A standardized, technology-enabled assessment solution that combines policy-aligned tools, trained assessors and integrated workflows to support scheduling, reporting, appeals tracking and consistent, equitable service determinations.
- Optum One Assist: A secure, scalable, omnichannel engagement platform that supports Medicaid and human services programs by improving contact center operations, enhancing service quality and delivering more seamless experiences for members, providers and stakeholders.
- State-Based Exchange / Integrated Eligibility / M&O Services: A set of modernization and operations capabilities that support eligibility and enrollment across programs, enable no-wrong-door access and provide end-to-end system implementation, operations and ongoing optimization.
- Optum Community Engagement Verification Solution: A solution that helps states meet community engagement requirements by combining verification services, secure integrations and optional AI-enabled automation for document processing and anomaly detection—without requiring changes to core eligibility systems.