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Senior Analyst, Regulatory Adherence - Remote - 2227079

UnitedHealth Group

UnitedHealth Group

IT, Legal
Eden Prairie, MN, USA
Posted on Sunday, June 9, 2024

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. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. This role can be remote or the employee can choose to work on site in Eden prairie, MN.

Primary Responsibilities:

  • Consistently evaluate and re-evaluate current procedures to ensure best-in-class practices are implemented
  • Lead cross-functional training to internal business partners
  • Working directly with internal business partners, clients, government auditors
  • Developing reports for leadership and cross functional teams to communicate current audit statuses, trends, and areas of opportunity
  • Developing and leading a consistent audit process to ensure all outside audits are effectively managed
  • Solves problems and develops innovative solutions
  • Monitor audit progress and resolve potential findings as appropriate
  • Monitor changes to laws and regulations to ensure compliance with State & Federal laws, regulations, and mandates
  • Analyzing the root cause of issues and aiding in development of appropriate action plans
  • Follow standard policies, procedures, and best practices across Optum Rx/UHG to promote compliance with applicable laws and contractual obligations
  • Assisting in or leading various special audits/projects as directed by the Director of Government Programs
  • Audit Support Travel as required (up to 10%)

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:

  • 3+ years of experience in a regulatory compliance role within in a managed care, government or health insurance environment
  • 3+ years Medicare D claims analysis experience
  • 1+ years of audit experience in a regulatory or operations role facilitating government audits including:
    • monitoring audit progress
    • analyzing the root cause of issues
    • aiding in development of appropriate action plans
    • resolving potential findings
  • Experience working within a PBM
  • Experience developing and leading a consistent audit process to ensure all outside audits are effectively managed
  • Experience monitoring changes to laws and regulations to ensure compliance with State & Federal laws, regulations, and mandates
  • Experience developing reports for leadership and cross functional teams to communicate current audit statuses, trends, and areas of opportunity
  • Experience managing multiple projects and competing deadlines
  • Intermediate or better proficiency using MS Word, MS Excel, and MS PowerPoint
  • Ability to travel up to 10%

Preferred Qualifications:

  • Experience interacting with government clients (regulators, auditors)
  • Experience working with RXCLAIM (or other PBM claim processing platform)
  • Experience writing and running SQL queries
  • Experience writing VBA code

*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy

California, Colorado, Connecticut, Hawaii, Nevada, New York, New Jersey, Rhode Island, or Washington Residents Only: The salary range for this role is $70,200 to $137,800 annually. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. UnitedHealth Group complies with all minimum wage laws as applicable. 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.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.