Sr. PBM Claims Audit Analyst -Telecommute

Company: UnitedHealth Group
Location: Orlando
Posted on: June 25, 2022

Job Description:

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that is improving the lives of millions. Here, innovation is not about another gadget; it is about making health care data available wherever and whenever people need it, safely and reliably. There is no room for error. If you are looking for a better place to use your passion and your desire to drive change, this is the place to be. It's an opportunity to do -your life's best work.(sm) You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities:

• Facilitate end to end management of external and internal client audits of pharmacy benefits and pricing
• Gather PBM plan documentation from internal teams to provide to external audit firm -
• Read and interpret plan design documents and PBM service agreements -
• Research historical claims and plan design set up in RxClaim -
• Track audit status and detail in SharePoint database and audit project plans -
• Respond to written audit reports from external Consulting / Auditing firms -
• Partner with Audit Consultant on complex external audits as assigned 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:
  • Bachelor's Degree or equivalent experience -
  • 3+ years of experience in PBM, Medical Benefits and/or Claims Audit experience
  • Project Management experience
  • Experience working in RxClaim or other similar claims adjudication system
  • Intermediate proficiency within Microsoft Office Suite (Excel, Word, PowerPoint) Preferred Qualifications:
    • Internal Audit experience
    • Experience working as a Pharmacy Technician within a PBM, Mail Order or Specialty setting
    • Experience performing presentations to internal and external stakeholders -
    • Experience prioritizing multiple project timelines simultaneously -
    • Experience tracking project plans -
    • Experience perfomring PBM claims audits
    • Experience interpreting PBM service agreements - To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, 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 with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm) *All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy. Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado residents is $54,400 to $97,000. The salary range for Connecticut/Nevada residents is $60,000 to $106,700. 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. 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. - - - - -

Keywords: UnitedHealth Group, Orlando , Sr. PBM Claims Audit Analyst -Telecommute, Accounting, Auditing , Orlando, Florida