Energize your career with one of Healthcare’s fastest growing companies.
You dream of a great career with a great company - where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.
This opportunity is with one of our most exciting business areas: Optum - a growing part of our family of companies that make UnitedHealth Group a Fortune 5 leader.
Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation and Performance.
Position in this function are responsible for the installation of assigned accounts, including, but not limited to: structure building and billing set up, structure revisions, researching and resolving structure issues, database loading, and preparation of plan materials such as administrative documents and customer education materials. Positions are responsible for overall employer contract loading using various databases and / or source documents. May research installation issues and develop customer specific resolutions. May include auditing contract loads for adherence to quality measures and reporting standards.
Audit contract loads for adherence to quality measures and reporting standards
Research errors by comparing Account Management documentation against multiple internal systems
Analyze and Research techniques to trend or quantify projects
Prepare, process, and maintain new group installation and renewals
Respond to member eligibility or group questions and verify enrollment status
Reconcile reports and group set up discrepancies, as well as analyzing transactional data and submitting retroactive eligibility changes
Research and respond to all claims processing inquiries from Client Management, Clinical, and other internal departments.
Perform claim testing to ensure accurate claim adjudication
Conduct installation of assigned accounts, including, but not limited to: structure building and billing set up, structure revisions, researching and resolving structure issues, database loading, and preparation of plan materials such as administrative documents and customer education material
Overall employer contract loading using various databases and / or source documents. May research installation issues and develop customer specific resolutions which may include auditing contract loads for adherence to quality measures and reporting standards
Perform other duties as assigned
Basic, structured, standard approach to work
Key Work and Accountabilities (Guidelines):
Develop decision trees (DTs) in RxAuth and Pega RXAUTH and PAS using plan specific clinical guideline criteria
Document testing of changes to or creation of DTs
Manage DT life cycle to ensure completion in accordance with deployment schedule
Work with RxAuth and RXAUTH and PAS IT support to overcome environmental challenges
Review client PA survey and ensure all key attributes exist for successful install
Maintain Pega RXAUTH and PAS decision and data tables for appropriate case processing
Triage RXAUTH and PAS Change Request, identify enhancement vs. biz rule update
Collaborate with RXAUTH and PAS dev team to provide solutions where possible
Work with RXAUTH and PAS IT support to overcome environmental challenges
Key Competencies / Capabilities needed to perform this role:
Utilize and understand Pega RXAUTH and PAS business rule functionality to provide 'business configurable' solutions
Able to identify system vs. user error
Listen to, understand, and anticipate solution
Critical thought process and analytical skills
Ability to drive task to completion despite significant challenge (collaborate, communicate)
High School Diploma / GED (or higher)
1+ years of experience in a healthcare insurance environment using the telephone and computer as the primary instruments to perform job duties
1+ year of experience in a PBM environment performing a benefit related function
Proficiency with Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications
Intermediate level of Microsoft Excel, must be able to navigate, create, open and save a spreadsheet. Must have the ability to sort, filter, and search spreadsheets as well as create formulas.
Data Entry experience (45+ WPM)
Ability to work a scheduled 8 hours shift within the hours of 8:00 am - 5:00 pm, Monday through Friday with the possibility of working overtime either before, after, or on a day other than your scheduled day
Undergraduate degree or higher - pharmacy or healthcare fields are preferred
Quality assurance experience
Pharmacy Technician and / or CPHT License
Proficiency with MS Word, Access and PowerPoint - must be able to open, create, edit, save, and send documents, presentations, and databases.
5+ years of experience in a healthcare insurance environment using the telephone and computer as the primary instruments to perform job duties
2+ year of experience in a PBM environment performing a benefit related function
Ability to be flexible and work in a constantly changing environment
Self - directed and the ability to prioritize caseloads based on business and customer needs
Physical Requirements and Work Environment:
Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, and long periods working at a computer
Service center environment with moderate noise level due to Representatives talking, computers, printers and floor activity
OptumRx is an empowering place for people with the flexibility to help create change. Innovation is part of the job description. And passion for improving the lives of our customers is a motivating factor in everything we do.
If you're ready to talk about groundbreaking interactions, let's talk about what happens when a firm that touches millions of lives decides to gather results from millions of prescriptions every month and analyze their impact. Let's talk about smart, motivated teams. Let's talk about more effective and affordable healthcare solutions. This is caring. This is great chemistry. This is the way to make a difference. We're doing all this, and more, through a greater dedication to our shared values of integrity, compassion, relationships, innovation and performance. Join us and start doing your life’s best work.SM
Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.
UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.
Keywords: Prior auth, prior authorization, PBM, Pharmacy, pharmacy technician, RXAUTH, PAS, RXClaim, Sharepoint, Business Rules, PresPlus Share, NewLeaf, Optum, OptumRx, UnitedHealthcare, UnitedHealthcare Group