Position Description: Working in Operations at OptumRx is 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. As an Associate Pharmacy Benefit Implementation Analyst, you will play a critical role in creating a quality member experience by accurately implementing and revising assigned pharmacy benefit plans. You will be responsible for constructing and revising prescription plans cost and coverage levels in alignment with the client's predetermined requirements. As an Associate Pharmacy Benefit Implementation Analyst, assets needed are, but not limited to: a high degree of personal accountability, be detail oriented, and have the 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, and the ability to work on multiple projects simultaneously and prioritize accordingly are necessities for this position. 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 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.Working Hours: 8-hour shift M-F with the potential for overtime as business needs dictate
Required Qualifications:High School Diploma / GED or higher 1+ years of experience in a Pharmacy or Healthcare Insurance / Pharmacy Benefit Management environment using the computer as the primary instrument to perform job duties 1+ years of experience creating documents and navigating in Microsoft Word 1+ years of experience sorting, filtering and analyzing data in Microsoft ExcelPreferred Qualifications:RxCLAIM experienceCPhT Certification (Certified Pharmacy Technician) Experience with pivot table, VLOOKUP and formulas in Microsoft Excel Soft Skills:Ability to multi-task and work independently and remain focused as tasks may change or alternate 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.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: OptumRx, Claim, pharmacy, benefit implementation
Internal Number: 754550
About UnitedHealth Group
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.