Title: Pharmacy Operations Analyst - Hartford, CT or Wilmington, NC
Other Locations: US-CT-Hartford
When you work in Operations at UnitedHealth Group, you can help improve the efficiency and usability of a system that''s going to change the face of health care.
If it sounds too good to be true, consider this: Through our family of businesses and a lot of inspired individuals, we''re building a high-performance structure that works better for more
people in more ways.
Primary Responsibilities for this position are:
- Overall employer contract loading and using various databases and/or source documents
- Research Installation Issues and develop customer specific resolution
- Audit contract loads for adherence to quality measures and reporting standards.
- Work with IT to ensure client requests are estimated and approved
- Research, resolve and streamline solutions for pharmacy service issues
- Handle escalated claims and client issues and research processes to prevent future occurrences
- Produce ad hoc pharmacy reporting for clients and account management teams
- Research, analyze and resolve eligibility issues with multiple PBM?s and various eligibility sources
- Organize and facilitate meetings across multiple PBMs.
- Research issues and engage appropriate areas to determine best solution to resolve global client issues
- Participate in the implementation of new CDH accounts with PBMs as pharmacy SME and benefit support
- Provide quality review of benefit set up and verification with PBMs to ensure uniformity between UHC and PBM
- Review test data for accuracy, and work with PBM and UHC IT to resolve any issues
Position in this function are responsible for the installation of assigned accounts, including, but not limited to: structure building and billing set up, structure revisions, researching & resolving structure issues, database loading, and preparation of plan materials such as administrative documents and customer education materials. Positions are responsible for overall employer contract loading using various databases and/or source documents. May research installation issues & develop customer specific resolutions. May include auditing contract loads for adherence to quality measures and reporting standards.
- Generally work is self-directed and not prescribed.
- Works with less structured, more complex issues.
- Serves as a resource to others.
* High School Diploma/GED is required
* 6 months of eligibility experience; i.e. familiarity with eligible files, ability to understand eligibility attributes
* 6 months of pharmacy experience; i.e. someone who has worked within a pharmacy environment and is familiar with the terminology
* Intermediate level of proficiency with MS Excel and Access (Excel/Access - reporting purposes and running formulas)
* Claims experience is a plus
* Bachelor's degree is preferred
UnitedHealthcare , part of the UnitedHealth Group family of companies, is comprised of three specialized businesses dedicated to meeting the health care benefits needs of individuals and groups; all part of something greater, but each with a specialized focus:
UnitedHealthcare Employer & Individual works with individuals, small businesses and large multi-site employers to provide innovative, affordable benefits services.
UnitedHealthcare Medicare & Retirement is focused on serving Americans over the age of 50. It is the largest business dedicated to meeting the growing health and well-being needs of aging individuals in the nation, serving one in five Medicare beneficiaries through a comprehensive and diversified array of products and services through four industry-leading businesses.
UnitedHealthcare Community & State provides high-quality, personalized, public-sector health care programs that help local government agencies improve health outcomes for millions of children and low-income and disabled individuals at an affordable cost.
Together, we''re removing the barriers that keep people from receiving the kind of quality health care that makes a difference. We focus on Integrity, Compassion, Relationships, Innovation and Performance as we empower people to achieve better health and well-being.
Come grow and thrive in our culture of innovation and ideas. Because there is no opportunity greater than the quest to help people live healthier lives.
Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/V.
UnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Job: Empl Contract Install & Implem