PBM Claims SME Business Analyst Consultant - Remote
About The Position
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. The Claims SME will serve as the subject matter expert regarding the ORX Claims system for all lines of business, Commercial, Medicare and Medicaid. The individual must have extensive knowledge of all Claim information, including how Claims are paid and rejected, why certain Claims are paid and rejected, and Member Cost Share information. 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
- 3+ years of experience in PBM business / RXclaims
- 3+ years PBM claims processing experience
- 1+ years of experience navigating through Medicare and Medicaid Claims issue investigations
- 1+ years of experience gathering requirements from the client / business and documenting
- 1+ years of experience with process improvement / streamlining
- Advanced level of proficiency with PC based software programs and automated database management systems (Excel)
- Comfort with client facing
Nice To Haves
- Experience using Tableau, Cognos, Rxclaim
- Proven ability to communicate analysis including trends and opportunities to clients and the business in writing and verbally
- Proven ability to solve problems including multiple priorities and research conflicting and/or inaccurate data
Responsibilities
- Serves as the primary OptumRx contact for the Health Plan client for Claims processing expertise, day to day management of IBX inquiries
- Must have solid communication skills
- Assist the account team with research, running ad hoc reporting requests, claims research, and client projects
- Work with operational areas on any development requests that require enhancements prioritizing and validation post the fix
- Assisting in any client specific implementations of new programs and testing as needed
- Proactive reject report review
- Attend client facing compliance meetings and on an as needed basis
- QA of impact (BIA) analysis
- Adhoc QA of new plan builds and plan changes as required
Benefits
- comprehensive benefits package
- incentive and recognition programs
- equity stock purchase
- 401k contribution
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
