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We have modest goals: Improve the lives of others. Change the landscape of health care forever. Leave the world a better place than we found it. Such aspirations tend to attract a certain type of person. Crazy talented. Compassionate. Driven. To these individuals, we offer the global reach, resources and can-do culture of a Fortune 5 company. We provide an environment where you’re empowered to be your best. We encourage you to take risks and in return, offer a world of rewards and benefits for performance. Exceeding your limits is an exceptional start to your life's best work.SM


Just like you, we are driven by a set of fundamental principles that are guiding our way forward. Our values of integrity, compassion, relationships, innovation, and performance serve as a foundation to transform health care. Are you in? Learn more about your future at UnitedHealth Group at careers.unitedhealthgroup.com


Job Category:

Enroll and Empl Contract Install



Approximate Salary:

Not Specified

Position Type:

Full Time

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Associate Pharmacy Benefit Implementation Analyst- Wausau, WI

UHG - Wausau, Wisconsin

Posted: 12/5/2018

Energize your career with one of Healthcare’s fastest growing companies.  


You dream of a great career with a great company – where you can make an impact and help people.  We dream of giving you the opportunity to do just this.  And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives.  We live for the opportunity to make a difference and right now, we are living it up.


This opportunity is with one of our most exciting business areas: Optum –a growing part of our family of companies that make UnitedHealth Group a Fortune 6 leader.


Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.

An Associate Pharmacy Benefit Implementation Analyst will play a critical role in creating a quality member experience by accurately implementing and revising assigned pharmacy benefit plans and will be responsible for constructing and revising prescription plans cost and coverage levels in alignment with the client’s predetermined requirements. Assets needed for an Associate Pharmacy Benefit Implementation Analyst are but not limited to; a high degree of personal accountability, detail oriented, and have the ability to analyze and solve complex problems with excellent conflict resolutions skills. Necessities for this position include; strong written and verbal skills, superior organizational skills, thinking outside of the box capabilities, and the ability to work on multiple projects simultaneously and prioritize accordingly.

Primary Responsibilities:

  • Analyze benefit requests and secure all necessary data to ensure appropriate implementation based on applied logic of RxCLAIM pharmacy claim adjudication system

    • Work with other cross-functional departments to implement new and maintain existing benefit plans and client pricing in the pharmacy claim adjudication system

    • Work with Clinical Pharmacy to implement formulary updates and clinical programs in the pharmacy claim adjudication system

    • Work with Pharmacy Network Management to implement pharmacy rate changes and network additions in the pharmacy claim adjudication system

  • Research and respond to all claims processing inquiries from Client Management, Clinical, and other OptumRx internal departments

  • Perform claim testing to ensure accurate claim adjudication

  • Run queries out of the RxCLAIM adjudication system to secure all necessary information to implement plan requests

  • Self-motivated to accomplish assigned tasks

  • Ability to work independently to maintain acceptable quality levels including timely communications of any issues and / or required information in order to complete plan requests within production turnaround time guidelines.

  • Utilize macros in RxCLAIM™ to implement plan requests.

  • Participate in team meetings

  • Perform other duties as assigned

Required Qualifications:
  • High School Diploma / GED (or higher)
  • 1+ years of experience in a pharmacy or healthcare insurance / PBM environment using the computer as the primary instrument to perform job duties
  • 1+ years of experience in using the computer as the primary instrument to perform job duties
  • Experience with Word, Excel & Outlook.  Word - Create Correspondence and work within templates.  Excel - Data Entry, Sort/filter, work within tables, V Lookups, Pivot Tables, utilize formulas.  Outlook - email and calendar management.
  • Ability to work an 8 hour shift Monday through Friday with the flexibility to adjust daily schedule, and work overtime and / or weekends as needed
Preferred Qualifications:
  • RxCLAIM™ experience
  • Certified Pharmacy Technician (CPhT ) certification
  • Retail pharmacy or PBM experience
Soft Skills:
  • Ability to multi-task and work independently and remain focused as tasks may change or alternate
OptumRx is an empowering place for people with the flexibility to help create change. Innovation is part of the job description. And passion for improving the lives of our customers is a motivating factor in everything we do.

If you're ready to talk about groundbreaking interactions, let's talk about what happens when a firm that touches millions of lives decides to gather results from millions of prescriptions every month and analyze their impact. Let's talk about smart, motivated teams. Let's talk about more effective and affordable healthcare solutions. This is caring. This is great chemistry. This is the way to make a difference. We're doing all this, and more, through a greater dedication to our shared values of integrity, compassion, relationships, innovation and performance. Join us and start doing your life’s best work.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Keywords: RXClaim; insurance; Pharmacy; PBM; Wausau; UHG; UnitedHealth

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