This position is National Remote. You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
The Benefit Operations Management (BOM) team is responsible for error free point of sale pharmacy script adjudication. A
Benefit Analyst will play a critical role by partnering with clients and Optum Rx stakeholders to assess, define, and perform pharmacy benefit implementations and ongoing maintenance within the RxCLAIM™ adjudication system. This work includes new plan builds, updates to existing plans, copy/change requests, and global updates. It's a fast paced, high-volume environment that requires you to work independently while maintaining a strong focus on company policies and guidelines. Accuracy is vitally important and subject to auditing internally and externally to ensure our system is correctly configured and aligned with client defined benefit requirements and performance guarantees.
Assets needed for a Benefit Analyst including, but not limited to, a high degree of personal accountability, detail oriented, and can analyze and solve complex problems with excellent conflict resolutions skills. Necessities for this position include timely strong written and verbal skills, superior organizational skills, thinking innovatively, and the ability to work on multiple projects simultaneously and prioritize accordingly.
This position is full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00 am - 5:00 pm local time. It may be necessary, given the business need, to work occasional overtime or weekends.
This will be on-the-job training and the hours during training will be 8:00 am - 5:00 pm local time, Monday - Friday.
Primary Responsibilities: - Analyze benefit requests and secure all necessary data to ensure appropriate implementation based on applied logic of RxCLAIM™ adjudication system
- Implement and maintain benefit requirements within the RxCLAIM™ adjudication system according to the client's intent and within required turnaround time
- Utilize system tools and follow documented processes to perform job functions
- Work with various cross-functional departments
- Perform validation of system benefit configuration and claim testing to ensure accurate adjudication
- Perform peer review as assigned
- Research and respond to all claims processing inquiries and issues from various cross-functional departments within required turnaround time
- Adhere to client performance guarantees, when applicable
- Perform quality assurance testing for system enhancements
- Assist in the development and roll out of BOM tools and processes
- Support projects and business initiative requirements
- Subject Matter Expert (SME) in new plan builds, updates to existing plans, copy/change requests, and global updates
- Mentor and train team members
- Participate in internal and external client meetings to meet demand
- Prepare documentation detailing plan features to share with internal and external clients
- Perform other duties as assigned
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications: - High School Diploma / GED OR equivalent work experience
- Must be 18 years of age OR older
- 2+ years of healthcare experience
- 1+ years of experience working with RxCLAIM™ adjudication system in a benefit analyst or related position, including ability to navigate the system and understand the functionality at a plan administration level
- Advanced level of proficiency in claims processing and issue resolution
- Experience with developing processes applicable to the department
- Proficiency with Microsoft Word (create and edit correspondence) and Microsoft Excel (ability to create, edit, and sort spreadsheets; apply basic analytical formulas)
- Benefit coding experience
- Ability to work full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00 am - 5:00 pm local time. It may be necessary, given the business need, to work occasional overtime or weekends.
Preferred Qualifications: - Certified Pharmacy Technician (CPhT)
- Retail pharmacy OR PBM experience
Telecommuting Requirements:- Ability to keep all company sensitive documents secure (if applicable)
- Required to have a dedicated work area established that is separated from other living areas and provides information privacy
- Must live in a location that can receive a UnitedHealth Group approved high-speed internet connection or leverage an existing high-speed internet service
Soft skills:- Engage with client by guiding and leading discussions along with supporting implementations
- Experience using critical thinking skills to articulate and inform stakeholders on solutions and issues
- Ability to comprehend, analyze data, and calculate results
- Ability to problem solve and make educated business decisions
- Proven ability to multi-task with attention to detail, remain focused and motivated in a fast paced, collaborative, and changing environment
- Excellent interpersonal, organizational, analytical and time management skills as well as the ability to independently manage projects and deadlines
- Capability to use tools and technology to perform daily functions
- Strong verbal and written communication skills
- Ability to work well independently and as a team
- Maintain a growth mind set
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $29.00 to $52.00 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
