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UnitedHealth Group Pharmacy Operations Analyst, Medicare and Retirement - Telecommute in Pittsburgh, Pennsylvania

UnitedHealthcare is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm)

This is a great opportunity to continue developing a career in Pharmacy! The Pharmacy Operations Analyst partners with the Pharmacy Account Manager (PAM), clinical teams, and pharmacy benefit manager (PBM) to interpret and execute pharmacy benefit design changes and implementations. The Pharmacy Operations Analyst also supports the Medicaid formulary by investigating, reviewing, and analyzing claims, creating formulary documentation, and maintaining formulary coding files. As a key link in the formulary administration process, you must maintain a high degree of attention to detail while remaining flexible in an ambiguous atmosphere. The ideal candidate would promote Our United Culture by acting with integrity and compassion, while fostering relationships and innovation, and of course – by performing!

This position is full-time (40 hours/week) Monday – Friday. Employees are required to work our normal business hours of 8:00am – 5:00pm.

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

  • Understand the end-to-end environment of pharmacy claims processes including point of sale adjudication

  • Support individual and team goals of affordability, excellence, engagement, compliance, and growth

  • Support long term activities by influencing or providing input to forecasting and planning discussions by reviewing, implementing, and testing benefit coding requests in partnership with the PBM

  • Work collaboratively with cross-functional and cross-organizational teams (PAM, PBM, clinical team) – build positive relationships, participate in calls and projects, prioritize tasks and projects to ensure timely completion and effective results

  • Able to work on more complex issues and projects by supporting assigned market(s) by investigating, reviewing, and analyzing claims data

  • Perform routine and moderately complex claims, plan build, and implementation audits to include root cause analysis by analyzing and, discrepancies, and opportunities

  • Provide explanations and interpretations within area of expertise at the manager/director level

  • Uses pertinent data and facts to identify and solve a range of problems within area of expertise

  • Other duties as assigned to include project support

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 pharmacy, pharmacy benefit, and/or PBM experience

  • 3+ years of healthcare/clinical experience within operations and/or clinical software to include RxClaim (AS400)

  • 3+ years of experience performing significant data analysis in a healthcare/corporate setting

  • 3+ years of experience with documenting processes and practices, while effectively prioritizing tasks, priorities, projects, and deadlines

  • 3+ years of experience facilitating and managing complex projects with technical, and process impacts to include issue resolution and remediation planning

  • Advanced proficiency with Microsoft Excel (has skills to perform VLOOKUP, SUM, COUNTIF, Pivot Tables, etc.)

Preferred Qualifications:

  • Bachelor’s degree in Business, Health Administration, or related field and/or equivalent work experience

  • Certified Pharmacy Technician

  • Claims auditing or SME experience and/or controls and performance monitoring experience

  • Experience with process automation (SAS, SQL, or Excel Macros)

  • Understanding of the end-to-end environment of pharmacy claims processes including point of sale adjudication, accumulation processes, and claim reprocessing

  • Excellent written and oral communication skills with a demonstrated ability to collaborate and communicate up to and through VP level stakeholders

  • Exceptional analytical and problem-solving skills

  • Natural ability to work independently and effectively prioritizes work and deadlines while being a resource for others

  • Full COVID-19 vaccination is an essential requirement of this role. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination prior to employment to ensure compliance

To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies now require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles require full COVID-19 vaccination as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment.

Careers at UnitedHealthcare Medicare & Retirement. The Boomer generation is the fastest growing market segment in health care. And we are the largest business in the nation dedicated to serving their unique health and well-being needs. Up for the challenge of a lifetime? Join a team of the best and the brightest to find bold new ways to proactively improve the health and quality of life of these 9 million customers. You'll find a wealth of dynamic opportunities to grow and develop as we work together to heal and strengthen our health care system. Ready? It's time to do your life's best work.(sm)

Colorado, Connecticut or Nevada Residents Only: The hourly range for Colorado residents is $25.63 to $45.72. The hourly range for Connecticut / Nevada residents is $28.27 to $50.29. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers 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 UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.

*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy

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.

Job Keywords: Pharmacy Operations Analyst, Medicare and Retirement, Operations Analyst, Analyst, Telecommute, Telecommuting, Telecommuter, Work From Home, Work At Home, Remote