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An Associate Pharmacy Benefit Implementation Analyst will play a critical role in creating a quality member experience by accurately implementing and revising assigned pharmacy benefit plans and will be responsible for constructing and revising prescription plans cost and coverage levels in alignment with the clients predetermined requirements. Assets needed for an Associate Pharmacy Benefit Implementation Analyst are but not limited to; a high degree of personal accountability, detail oriented, and have the ability to analyze and solve complex problems with excellent conflict resolutions skills. Necessities for this position include; strong written and verbal skills, superior organizational skills, thinking outside of the box capabilities, and the ability to work on multiple projects simultaneously and prioritize accordingly.
Analyze benefit requests and secure all necessary data to ensure appropriate implementation based on applied logic of RxCLAIM pharmacy claim adjudication system.
Work with other cross-functional departments 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.
Research and respond to all claims processing inquiries from Client Management, Clinical, and other OptumRx internal departments.
Perform claim testing to ensure accurate claim adjudication.
Run queries out of the RxCLAIM adjudication system to secure all necessary information to implement plan requests
Self-motivated to accomplish assigned tasks.
Ability to work independently to maintain acceptable quality levels including timely communications of any issues and/or required information in order to complete plan requests within production turnaround time guidelines.
Utilize macros in RxCLAIM to implement plan requests.
UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.
We are committed to introducing innovative approaches, products and services that can improve personal health and promote healthier populations in local communities. Our core capabilities... in clinical care resources, information and technology uniquely enable us to meet the evolving needs of a changing health care environment as millions more Americans enter a structured system of health benefits and we help build a stronger, higher quality health system that is sustainable for the long term.
We serve our clients and consumers through two distinct platforms:
?UnitedHealthcare, which provides health care coverage and benefits services.
?Optum, which provides information and technology-enabled health services.