Benefit Analyst

UnitedHealth Group•Tampa, FL

9h•$29 - $52•Remote

About The Position

The Benefit Operations Management (BOM) team is responsible for error-free point-of-sale pharmacy script adjudication. A Benefit Analyst 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 a Benefit Analyst including, but not limited to, a high degree of personal accountability, detail-oriented, and can analyze and solve complex problems with excellent conflict resolution 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 work 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 on-the-job training and the hours during training will be 8:00 am - 5:00 pm local time, Monday - Friday.

Requirements

High School Diploma / GED OR equivalent work experience
Must be 18 years of age OR older
2+ years of healthcare experience
1+ years of experience working with RxCLAIM™ adjudication system in a benefit analyst or related position, including ability to navigate the system and understand the functionality at a plan administration level
Advanced level of proficiency in claims processing and issue resolution
Experience with developing processes applicable to the department
Proficiency with Microsoft Word (create and edit correspondence) and Microsoft Excel (ability to create, edit, and sort spreadsheets; apply basic analytical formulas)
Benefit coding experience
Ability to work full-time, Monday - Friday. Employees are required to work 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.
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
Engage with client by guiding and leading discussions along with supporting implementations
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
Proven ability to multi-task with attention to detail, remain focused and motivated in a fast paced, collaborative, and changing environment
Excellent interpersonal, organizational, analytical and time management skills as well as the ability to independently manage projects and deadlines
Capability to use tools and technology to perform daily functions
Strong verbal and written communication skills
Ability to work well independently and as a team
Maintain a growth mind set
All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
Candidates are required to pass a drug test before beginning employment.

Nice To Haves

Certified Pharmacy Technician (CPhT)
Retail pharmacy OR PBM experience

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
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
Perform quality assurance testing for system enhancements
Assist in the development and roll out of BOM tools and processes
Support projects and business initiative requirements
Subject Matter Expert (SME) in new plan builds, updates to existing plans, copy/change requests, and global updates
Mentor and train team members
Participate in internal and external client meetings to meet demand
Prepare documentation detailing plan features to share with internal and external clients
Perform other duties as assigned