The job below is no longer available.

You might also like

in Minnetonka, MN

Use left and right arrow keys to navigate
Hours Full-time, Part-time
Location Minnetonka, MN
Minnetonka, Minnesota

About this job

Position Description:

You believe data can help reshape the future, and you find yourself loving the thrill of diving into challenging analysis. At UnitedHealth Group, you'll find an organization that will recognize those talents and have lots of growth potential. Here, you will be empowered, supported and encouraged to use your analysis expertise to help change the future of health care. Does the challenge intrigue you?

As a key member of the Analyst team, you will be part of UnitedHealth Group's mission of helping people live healthier lives. As a Senior Business Analyst, you will grow and develop as you conduct and manage outcomes of various studies. You will be challenged to analyze, review, and forecast data for operational and business planning. As part of this elite team, you will be empowered to impact the health care system through the analysis and interpretation of data, and presenting recommendations for business solutions. Join us! There's never been a better time to do your life's best work.(SM)

UnitedHealthcare Medicare & Retirement (UHMR) Pharmacy Management team provides pharmacy benefit operations services, formulary and clinical operations services, and is responsible for executing oversight and monitoring activities of UHMR?s first-tier, downstream and related entities (FDR). The Pharmacy Management team?s primarily focus relates to UHMR?s pharmacy benefit management (PBM) services provided by OptumRx. UHMR is a family of UnitedHealth Group businesses dedicated to improving the health and well-being of Americans ages 50 and older.

UHMR Pharmacy Management is searching for an expert problem-solver with experience in Medicare Part D claims processing and business processes to join our team in Minnetonka, MN as the Pharmacy Operations Analyst supporting Part D audits. In this growth-oriented role, you will report to the Director, Pharmacy Management and play a key role in supporting Part D Audits and related business activities as a member of the Pharmacy Management Audit Support Team.

Positions in this function conduct and manage outcomes of various studies that include analyzing, reviewing, forecasting, trending, and presenting information for operational and business planning. They support short and long term operational/strategic business activities - by developing, enhancing and maintaining operational information and models. They also develop and implement effective/strategic business solutions through research and analysis of data and business processes.

Primary Responsibilities:
  • Analyze, review, forecast, and trend complex data 
  • Present analysis and interpretation for operational and business review and planning 
  • Support short and long term operational/strategic business activities through analysis 
  • Develop recommended business solutions through research and analysis of data and business process and implement when appropriate
  • Understand the overall business model of Medicare Part D products, CMS guidance and the PBM claim adjudication system and translate concepts into practice
  • Support CMS audit initiatives by investigating samples, identifying scenarios of concern, and researching claims within the pharmacy system.
  • Drive follow-up activities required to address identified gaps 
  • Collaborate with business stakeholders and PBM to obtain necessary information to support audits.
  • Support Oversight & Monitoring business activities related to paid and rejected claim reviews and member impact reporting and remediation.
  • Participate in business requirements development and system testing, research and analyze claim data for root cause identification, correction and remediation. 
  • Support development of Audit Support team infrastructure
  • Support for ongoing Audit Readiness activities
  • Prioritize and organize own work to meet deadlines
  • Generally work is self-directed and not prescribed.
  • Works with less structured, more complex issues.
  • Serves as a resource to others.

Requirements

Required Qualifications:
  • Bachelor's Degree OR HS diploma/GED with 4+ years of equivalent work experience.
  • 3+ years Medicare Part D/Pharmacy benefit, and/or PBM experience related to eligibility, benefits and/or claims adjudication.
  • Proficiency with Microsoft Word and Power Point.  
  • Experience in Excel including pivot tables, basic formulas, and importing and exporting data.
  • Experience with business analysis and continuous process improvement.
  • Experience working in a Matrix environment.
  • 2+ years' experience analyzing large amounts of data and handle complex requests.
  • 1+ year reporting expertise
Preferred Qualifications:
  • Certified Pharmacy Technician experience.
  • Experience with Pharmacy Claim Analysis and quality practices.
  • Knowledge of RxClaim (claims processing system).
  • Proficiency with either SAS or SQL and Oracle/SQL.
  • Proficiency with SharePoint and Visio.
  • Knowledge of Medicare Part D guidelines and regulations.
  • Ability to travel up to 10%.
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


Diversity creates a healthier atmosphere: 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.