Associate Director, Network Pricing - Drug Pricing & Claims Integrity -Remote

UnitedHealth Group•Eden Prairie, MN

1d•$112,700 - $193,200•Remote

About The Position

Optum Rx, a UnitedHealth Group company, with over 24,000 employees globally, specializes in the delivery, clinical management and affordability of prescription medications and consumer health products. Our goal is to deliver high-quality, integrated services to promote optimal outcomes, superior savings and outstanding client and consumer experiences. We make healthier happen by creating smarter health care connections to help more than 65 million consumers nationwide realize improved care, lower costs, and a better overall experience. This is a place like no other and where you’ll do your life’s best work. OptumRx is looking for a curious, adaptable, and self-motivated Associate Director to be part of our Network Pricing team as a leader in Drug Pricing & Claims Integrity. This is an advanced analytics role where you will learn and apply the business fundamentals of drug pricing, claims adjudication platform logic, the underlying data flows, and the tools and systems used in this type of financial analysis. The person in this role will work with and have regular exposure to analysts and projects in our global data science and network pricing teams. The role partners closely with Network Contracting, Pricing, Technology, Compliance, and Operations teams to ensure that contract terms, reimbursement methodologies, and regulatory requirements are correctly translated into adjudication logic and consistently executed at the point of sale. Position Description: Supports and validates unit cost management activities through financial and network pricing modeling, analysis, and reporting. This role is responsible for ensuring accurate pharmaceutical drug pricing and claims adjudication across the pharmacy network by validating pricing logic, adjudication configuration, and contractual compliance within the claims platform (RxClaim). The position focuses on identifying, researching, and correcting claims pricing discrepancies, coding or configuration errors, and pharmacy contract misalignment, with specific accountability for Medicare and CMS compliance requirements, including Plan Finder accuracy. You’ll enjoy the flexibility to work remotely from anywhere within the U.S. as you take on some tough challenges. For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Requirements

7+ years of experience in pharmaceutical pricing, claims adjudication, healthcare financial modeling, or PBM operations
Solid analytical skills with experience building and validating financial models, pricing validations, or audit controls
PBM experience
Proven ability to interpret contracts, reimbursement methodologies, and pricing guarantees
Proven ability to understand end‑to‑end claims or data workflows and diagnose anomalies across pricing, configuration, and process
Proven excellent written and verbal communication skills, with the ability to clearly explain complex pricing and adjudication issues to diverse audiences

Nice To Haves

Direct experience with RxClaim or a comparable pharmacy claims adjudication platform
Experience designing or executing claims audits, pricing QA, or compliance validation frameworks

Responsibilities

Own end‑to‑end accountability for prescription drug pricing accuracy and claims adjudication outcomes, from pricing strategy and financial modeling through configuration, validation, and ongoing monitoring
Develop and maintain financial models to support drug pricing strategy, unit cost targets, reimbursement methodologies, and performance analysis
Set and validate drug pricing parameters to ensure accurate execution of pharmacy contracts, reimbursement logic, and benefit design within the adjudication platform (RxClaim)
Identify, research, and resolve claims pricing discrepancies, including incorrect reimbursement or misconfiguration of pricing and adjudication logic
Perform claims research, adjustments, and corrections as appropriate; identify patterns or systemic issues requiring broader remediation
Interpret pharmacy contracts and ensure contractual terms are accurately translated into adjudication logic, identifying gaps between negotiated terms and live claims behavior
Ensure adherence to state and federal regulatory requirements, including CMS and Medicare (Plan Finder) pricing and compliance standards, and support remediation of identified issues
Partner with network, pricing, compliance, analytics, and technology teams to validate assumptions, resolve issues, and deploy accurate, compliant pricing solutions
Communicate complex pricing, adjudication, and compliance findings clearly to technical and non‑technical stakeholders, including senior leadership
Establish and maintain repeatable workflows, documentation, and internal controls to support compliant, scalable pricing logic and adjudication configuration
Provide guidance and direction to team members, as applicable, and lead cross‑functional initiatives impacting pricing accuracy and claims integrity