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.
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
- 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
- RxCLAIM™ experience
- Certified Pharmacy Technician (CPhT ) certification
- Retail pharmacy or PBM experience
- Ability to multi-task and work independently and remain focused as tasks may change or alternate
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