Benefit Analyst

UnitedHealth Group•Tampa, FL

11h•Remote

About The Position

This position is National Remote. You’ll enjoy the flexibility to telecommute from anywhere within the U.S. as you take on some tough challenges. 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. 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.

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 (40 hours/week) Monday - Friday, with flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 AM - 5:00 PM in local time zone
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 clients 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 solve problems 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.

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