Eligibility Analyst - Remote
Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Come make an impact on the communities we serve as we help advance health equity on a global scale. Here, you will find talented peers, comprehensive benefits, a culture guided by diversity and inclusion, career growth opportunities and your life's best work.(sm)
You’ll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges.
- Reviews eligibility data from clients to ensure accuracy of transmitted information. Recommends changes or corrections to client files or OptumRx eligibility fields with the claims system
- Works with client to coordinate method of data transmission to the OptumRx Production Systems department for file loading
- Ensures group / plan structure determinations are entered accurately and timely so that benefits and enrollment can be loaded into the OptumRx system properly. Provides quality assurance checks to ensure all fields are complete and able to be processed in the OptumRx claims system
- Attends implementation meetings with clients and OptumRx staff to discuss eligibility requirements and protocols. Recommends eligibility file formats to clients and coordinates the receipt and processing of eligibility data
- Maintains published timelines for receiving and processing client eligibility information and communicates targets to OptumRx staff and clients. Coordinates with client to ensure the timely receipt and processing of eligibility data
- Analyzes eligibility reports, and researches and resolves discrepancies, errors, and problems to ensure that all claims are accurately processed with respect to eligibility data, and that all new plans are implemented according to established OptumRx and client guidelines
- Coordinates with Implementation group to determine proper client hierarchy for client billing and reporting
- Acts as liaison between client and OptumRx to coordinate receipt of required prescriber information for reporting and claim adjudication process for new and existing plans
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.
- HS Diploma or GED
- 1+ years of experience working with internal and external clients
- 1+ years of experience working in the PBM industry
- Experience working with various data file layouts, transferring data files, and translating file formats
- Experience managing multiple priorities in a fast-paced business environment where adherence to strict processes and deadline
- Intermediate or better proficiency using MS Office Suite (Excel, Word, Outlook, etc.)
- Proven ability to
provide client consultation and facilitate client meetings over the phone and face-to-face
- Bachelor’s degree in Business, Finance, Economics, or related
- 5+ years of experience working in the PBM industry
- 1+ years of experience working in eligibility within the PBM industry
- RxClaim platform experience
- Medicare Part-D experience
- Experience using MS Visio and MS Project
- Excellent communication, time/project management, problem solving, organizational, and analytical skills
- Team player - able to build solid relationships with internal business partners and external clients
- Meticulous and high level of attention to detail
Careers with OptumRx. We're one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. Here you’ll fill far more than prescriptions. As a member of one of our pharmacy teams, you’re empowered to be your best and do whatever it takes to help each customer. You'll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There's no better place to help people live healthier lives while doing your life's best work.(sm)
California, Colorado, Connecticut, Nevada, New York City, or Washington Residents Only: The hourly range for California, Colorado, Connecticut, Nevada, New York City, or Washington residents is $22.45 to $43.89. 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 employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone–of every race, gender, sexuality, age, location and income–deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes — an enterprise priority reflected in our mission.
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.
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