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An Associate Employer Installation Specialist 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.
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.BOM 2016 Proprietary and Confidential 2
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 or GED or higher
- Ability to Work 8 hour shift Monday-Friday with the potential for overtime as business needs dictate
- 1+ years of experience in a pharmacy or healthcare insurance / PBM environment using the computer as the primary instrument to perform job duties
- Experience in Microsoft Office: Word- with the ability to create documents, Excel- with the ability to create spreadsheets sort and filter data and Outlook tools with the ability to learn new applications
- RxCLAIM™ experience
- Certified Pharmacy Technician (CPhT ) certification
- Ability to multi-task and work independently and remain focused as tasks may change or alternate
- Have a high degree of personal accountability
- Detail oriented
- Ability to analyze and solve complex problems with excellent conflict resolutions skills
- Strong written and verbal skills
- Superior organizational skills
- Thinking outside of the box capabilities
- Ability to work on multiple projects simultaneously and prioritize accordingly
- Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, and long periods working at a computer
- Service center environment with moderate noise level due to Representatives talking, computers, printers and floor activity
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.SM
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: Associate Installation Specialist; Pharmacy Benefit Implementation Analyst