Position Responsibilities: 

• 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 Client Management to implement new and maintain existing benefit plans and client pricing in the pharmacy claim adjudication system.
• Work with Clinical Pharmacy to implement formulary updates and clinical programs in the pharmacy claim adjudication system.
• Work with Pharmacy Network Management to implement pharmacy rate changes and network additions in the pharmacy claim adjudication system.
• Ensure timely communication of any issues and/or information needed to complete a plan request.
• Develop client specific implementation plans and manage implementation processes in accordance with department protocol.
• 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 turn around 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

Requirements:

• High school diploma or GED
• 2+ years of PBM or retail pharmacy experience
• Beginner to Intermediate level proficiency with Word and Excel

Assets:

• Undergraduate degree preferred
• Certified pharmacy technician preferred
• 2+ years of RxClaim experience preferred

OptumRx is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system.

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 health care 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.

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. In the largest and most personal sense, your impact can be greater than even you thought at OptumRx.

Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V

UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.