Position Description:Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.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. Assets needed for an Associate Employer Installation Specialist 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 higherWorking Hours: 8 hour shift M-F with the potential for overtime as business needs dictate1+ years of experience in a Pharmacy or Healthcare Insurance / PBM environment using the computer as the primary instrument to perform job dutiesFamiliarity with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications1+ years of experience in using the computer as the primary instrument to perform job dutiesPreferred Qualifications:RxCLAIM™ experienceCertified Pharmacy Technician (CPhT) CertificationRetail Pharmacy or PBM experience Soft Skills: Ability to multi-task and work independently and remain focused as tasks may change or alternatePhysical Requirements and Work Environment:Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, and long periods working at a computerService center environment with moderate noise level due to Representatives talking, computers, printers and floor activityOptumRx 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.SMDiversity 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: Cypress, UHG, computer, phone, pharmacy
Our mission is to help people live healthier lives and to help make the health system work better for everyone.- We seek to enhance the performance of the health system and improve the overall health and well-being of the people we serve and their communities. - We work with health care professionals and other key partners to expand access to quality health care so people get the care they need... at an affordable price. - We support the physician/patient relationship and empower people with the information, guidance and tools they need to make personal health choices and decisions.