Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
The Benefit Operations Management (BOM) team is responsible for error free point of sale pharmacy script adjudication. An Associate Benefit Specialist 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 an Associate Benefit Specialist 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 have flexibility to work any of our shift schedules during 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 paid on-the-job training and the hours during training will be 8:00 AM - 5:00 PM local time from Monday - Friday.
You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
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 to implement new and maintain existing benefits within the RxCLAIM adjudication system including, but not limited to:
Client and Pharmacy pricing
Formulary updates
Clinical programs
Specialty drug pricing
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
Participate in meetings assigned by leadership
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
1+ years of healthcare experience
Proficiency with Microsoft Word (create and edit correspondence) and Microsoft Excel (ability to create, edit, and sort spreadsheets; apply basic analytical formulas)
Ability to work any of our shift schedules during our normal business hours of 8:00 AM - 5:00 PM local time from Monday - Friday. It may be necessary, given the business need, to work occasional overtime or weekends.
Preferred Qualifications:
Certified Pharmacy Technician (CPhT)
RxCLAIM OR other claim adjudication experience
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:
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
Strong verbal and written communication skills
Ability to work well independently and as a team
Maintain a growth mind set
Excellent interpersonal, organizational, analytical and time management skills as well as the ability to independently manage projects and deadlines
Proven ability to multi - task with attention to detail, remain focused and motivated in a fast paced, collaborative, and changing environment
Ability to use tools and technology to perform daily functions
Experience in implementing and maintaining benefits
*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
The hourly range for this role is $23.70 to $46.35 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you'll find a far-reaching choice of benefits and incentives.
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.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
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