Requisition number: 2361880
Job category: Sales Support
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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.
This position is full-time (40 hours/week) Monday - Friday. Employees are required to have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00am - 5:00pm EST (will support Eastern Time Zone). It may be necessary, given the business need, to work occasional overtime.
You will enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
Independently manages complex, high risk, or escalated benefit configuration work, including new client implementations and critical renewals
Serves as a primary SME for BCT processes, systems (ServiceNow, RxCOMET, RxClaim/NextGen, RxCCR), and SOP updates
Provides guidance and peer support to analysts on benefit logic, system impacts, and troubleshooting
Performs advanced data review and validation to ensure benefit accuracy, compliance, and alignment with documented client intent
Partners with triage, upstream, and downstream teams (e.g., BOM, Formulary, Specialty, CCR) to resolve issues, clarify requirements, and route work appropriately
Engages in issue research, escalation support, and root cause identification to prevent repeat errors
Support new and existing client benefit changes by submitting, monitoring, and maintaining work through ServiceNow cases and tasks
Complete structured analysis and validation of benefit data to ensure accuracy and compliance with documented client intent
Maintain consistent quality standards while meeting established turnaround time (TAT) and performance metrics
Utilize SOPs, job aids, and source systems to research issues, resolve discrepancies, and ensure correct benefit configuration
Monitor assigned work queues, perform required follow up, and ensure tasks progress to completion
Maintain thorough documentation and professional handling of all assigned work items
What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:
Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
Medical Plan options along with participation in a Health Spending Account or a Health Saving account
Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
401(k) Savings Plan, Employee Stock Purchase Plan
Education Reimbursement
Employee Discounts
Employee Assistance Program
Employee Referral Bonus Program
Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions 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
3+ years of PBM related experience
3+ years of experience in a business analyst, Subject Matter Expert (SME), or similar role responsible for implementing and upkeeping complex, cross functional business processes
3+ years of experience performing complex benefit change analysis and system configuration work
Advanced level of proficiency working across multiple systems concurrently (e.g., ServiceNow, RxCOMET, RxClaim/NextGen, RxCCR)
Intermediate level of proficiency in Microsoft Office skills, including Word, Excel, Teams, Outlook & OneNote
Strong analytical skills, attention to detail, and ability to work independently in a telecommuter environment
Proven ability to meet established turnaround time, SLA, and quality benchmarks
Individual contributor with the ability to organize information and multi-task work items, while maintaining strong attention to detail
Preferred Qualifications:
3+ years of BCT experience
Strong working knowledge of UMR benefit change processes and procedures
Recognized experience acting as an SME, trainer, or peer resource within a PBM or benefits configuration environment
Experience handling escalations, high-impact client changes, or peak-volume workloads
Familiarity with SOP development, process stabilization, and supporting large changes
Strong communication skills and experience partnering cross-functionally to resolve complex issues
*All Telecommuters 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 $28.94 to $51.83 per hour based on full-time employment. We comply with all minimum wage laws as applicable.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
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.
RPO #GREEN
