PBM Claims SME Business Analyst Consultant - Remote

Requisition Number: 2360832
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.
Primary 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

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear direction on what it takes to succeed in your role as well as provide development for other roles you may be interested in.
Required Qualifications:

• 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

Preferred Qualifications:

• 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

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy
Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 to $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.
Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.
UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.