About UHG

Careers at UnitedHealth Group


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:

Business Operations


United States

Postal Code:


Approximate Salary:

Not Specified

Position Type:

Full Time

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Pharmacy Operations Analyst – Pittsburgh, PA

UHG - Pittsburgh, Pennsylvania

Posted: 09/4/2018

Pharmacy careers at UnitedHealth Group. We're changing the way health care works for the better. That means consulting with our members, partnering with our physicians and delivering drugs in the most efficient and effective way. As one of the largest pharmacy benefits managers in the United States, we provide a professional culture where you're empowered and encouraged to exceed the expectations of our members. With better schedules than retail and more reach than any hospital, you'll find daily opportunities to grow your knowledge and many paths to move up and around our global company. Learn more. Join us and start doing your life’s best work.(sm)


Pharmacy Operations Analyst investigates, reviews and analyzes claims data applying knowledge of pharmacy policy and practice and data mining techniques to determine details of erroneous claims activity. Provides administrative and operational support for various Community and State formularies; including formulary document creation, formulary quick reference guides, formulary update bulletins, distribution of formulary information, maintaining formulary coding files, communicating formulary updates to PBM, working in concert with the clinical services department to interpret pharmacy benefit design changes and coordinate implementation of changes across the organization. Investigates and resolves formulary coding issues.


Primary Responsibilities:

  • Support assigned region by investigating, reviewing, and analyzing claims data by applying knowledge of pharmacy policy to ensure claims have processed appropriately based on benefit design and preferred drug list
  • Auditing claims
  • Analyzes, investigates, and manipulates data
  • Provides explanations and interpretations within area of expertise
  • Accurately submits benefit coding requests to OptumRx to update pharmacy point of sale claims processing
  • Review testing of benefit coding requests
  • Other duties as assigned

Required Qualifications:

  • Bachelor's Degree
  • Advanced Excel Skills (use of functions in Excel such as vlookup, sum, countif, etc)
  • Intermediate computer proficiency in Microsoft Office programs  

Preferred Qualifications:

  • Retail Pharmacy experience
  • Certified Pharmacy Technician
  • Experience working in a pharmacy call center environment
  • Auditing experience
  • Investigative and dispensing experience
  • Experience in team interactions, performance matrix and improvement methods / projects (e.g., coaching, quality, productivity)
  •  Microsoft Access, AS 400 and/or Rx Claims system
  • Six Sigma Process Improvement Experience
  • Coding and/or Macro Experience
  • Work experience requiring strong organizational skills and multitasking abilities
  • 1+years of Pharmacy experience
Careers with UnitedHealthcare. Let's talk about opportunity. Start with a Fortune 6 organization that's serving more than 85 million people already and building the industry's singular reputation for bold ideas and impeccable execution. Now, add your energy, your passion for excellence, your near-obsession with driving change for the better. Get the picture? UnitedHealthcare is serving employers and individuals, states and communities, military families and veterans where ever they're found across the globe. We bring them the resources of an industry leader and a commitment to improve their lives that's second to none. This is no small opportunity. It's where you can do your life's best work.(sm)


 Diversity creates a healthier atmosphere: 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.


Job Keywords: Iowa2015, Pharmacy, Pharmacy Technician, CPhT, retail pharmacy, data analyst, Pittsburgh, PA, Pennsylvania


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