Note: The job is a remote job and is open to candidates in USA. Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The Associate Benefit Analyst will partner with clients and Optum Rx stakeholders to assess, define, and perform pharmacy benefit implementations and ongoing maintenance within the RxCLAIM™ adjudication system, ensuring accurate benefit configurations and compliance with client requirements.
Responsibilities
- Analyze benefit requests and secure all necessary data to ensure appropriate implementation based on applied logic of RxCLAIM™ adjudication system
- Implement and maintain benefit requirements within the RxCLAIM™ adjudication system according to the client's intent and within required turnaround time
- Utilize system tools and follow documented processes to perform job functions
- Work with various cross-functional departments to implement new and maintain existing benefits within the RxCLAIM™ adjudication system including, but not limited to:
- Client and Pharmacy pricing
- Formulary updates
- Clinical programs
- Specialty drug pricing
- Perform validation of system benefit configuration and claim testing to ensure accurate adjudication
- Perform peer review as assigned
- Research and respond to all claims processing inquiries and issues from various cross-functional departments within required turnaround time
- Adhere to client performance guarantees, when applicable
- Participate in meetings assigned by leadership
- Perform other duties as assigned
Skills
- High School Diploma / GED OR equivalent work experience
- Must be 18 years OR older
- 1+ years of healthcare experience
- RxCLAIM™ or other claim adjudication experience
- Proficiency with Microsoft Word (create and edit correspondence) and Microsoft Excel (ability to create, edit, and sort spreadsheets; apply basic analytical formulas)
- Ability to work full-time, Monday - Friday. Employees are required to work our normal business hours of 8:00 am - 5:00 pm local time. It may be necessary, given the business need, to work occasional overtime or weekends
- Certified Pharmacy Technician (CPhT)
- Retail pharmacy or PBM experience
Benefits
- A comprehensive benefits package
- Incentive and recognition programs
- Equity stock purchase
- 401k contribution (all benefits are subject to eligibility requirements)
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