Position Description:
Working in Operations at UnitedHealth Group is one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.
If it sounds too good to be true, consider this: Through our family of businesses and a lot of inspired individuals, we're building a high-performance structure that works better for more people in more ways.
Primary Responsibilities:
- Overall employer contract loading and using various databases and/or source documents
- Research Installation Issues and develop customer specific resolution
- Audit contract loads for adherence to quality measures and reporting standards.
- Analyze benefit requests and secure all necessary data to ensure appropriate. Implementation based on applied logic of RxCLAIM (by SXC) pharmacy claim adjudication system.
- Work with Benefit Operations Leads to implement new and maintain existing benefit plans and client pricing in the pharmacy claim adjudication system.
- Work with Benefit Operations Leads to implement formulary updates and clinical programs in the pharmacy claim adjudication system.
- Ensure timely communication of any issues and/or information needed to complete a plan request.
- Run queries out of the RxCLAIM adjudication system to secure all necessary information to implement plan requests.
- Develop and run macros in RxCLAIM to implement plan requests.
- Perform claim testing to ensure accurate claim adjudication.
- Maintain acceptable and appropriate quality levels and production turnaround times
- Adhere to all documentation standards within the department.
- Assist with the development of process improvements for the department.
- Research and respond to all claims processing inquiries from Client Management, Clinical, and other internal department.
- Participate in team meetings.
- May be assigned to work on special projects and business initiatives.
- Performance Standard
- Ability to maintain an accuracy rate of 98% or better
- Adherence to company attendance policy
- Able to work independently
- Completes assigned projects on time
- BOM Benefit Analyst I Job Description Skills
- Strong written and verbal skills;
- Detail-oriented;
- Superior organization skills;
- Ability to work on multiple project simultaneously;
- Excellent analytical skills.
- Analyzes and investigates
- Provides explanations and interpretations within area of expertise.
- Responsible for the installation of assigned accounts, including, but not limited to: structure building and billing set up, structure revisions, researching & resolving structure issues, database loading, and preparation of plan materials such as administrative documents and customer education materials.
- Responsible for overall employer contract loading using various databases and/or source documents. May research installation issues & develop customer specific resolutions.
- May include auditing contract loads for adherence to quality measures and reporting standards.
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