At UnitedHealthcare, we’re simplifying the health care experience, creating healthier communities and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the health care system of tomorrow, making it more responsive, affordable and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

We’re looking for an operator who sees data as a language, has a relentless drive for quality, and is growth minded. The Pharmacy Operations Analyst partners with the Pharmacy Account Manager (PAM), clinical teams, and pharmacy benefit manager (PBM) to interpret and execute pharmacy benefit design changes and implementations. The Pharmacy Operations Analyst also supports the Medicaid formulary by investigating, reviewing, and analyzing claims, creating formulary documentation, and maintaining formulary coding files. As a key link in the formulary administration process, you must maintain a high degree of attention to detail while remaining flexible in an ambiguous atmosphere. The ideal candidate would promote Our United Culture by acting with integrity and compassion, while fostering relationships and innovation, and of course – by performing!

This position is full-time (40 hours/week) Monday – Friday. Employees are required to work our normal business hours 8:00am – 5:00pm.

You’ll enjoy the flexibility to work remotely* from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Translate strategy and intent into technical coding documents
• Perform routine and moderately complex claim, plan build, and implementation analysis
• Work collaboratively with cross-organizational teams (PAM, PBM, clinical) – build positive relationships, participate in calls and projects, and ensure on-time quality results
• Lead complex project and issue resolution in assigned market(s)
• Audit processes by analyzing and interpreting data to identify differences, discrepancies, and opportunities
• Provide explanations and interpretations within area of expertise at the manager/director level
• Leverage data and facts to identify and solve a range of problems within area of expertise
• Other duties as assigned to include project support

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 pharmacy, pharmacy benefit, and/or PBM experience
• 3+ years of experience performing significant data analysis in a healthcare/corporate setting
• 2+ years of experience with documenting processes and practices while effectively prioritizing tasks, priorities, projects, and deadlines
• Advanced level of knowledge and experience with RxClaim (AS400) – must be able to translate data, strategy, and intent into coding documents
• Advanced proficiency with Microsoft Excel (skills to perform VLOOKUP, SUM, COUNTIF, Pivot Tables, etc.)
• Excellent written and oral communication skills with a demonstrated ability to collaborate and communicate up to and through Director level stakeholders

Preferred Qualifications:

• Bachelor’s degree in Business, Health Administration, or related field and/or equivalent work experience
• Certified Pharmacy Technician
• Claims auditing or SME experience and/or controls and performance monitoring experience
• Experience with process automation (SAS, SQL, or Excel Macros)
• Understand the end-to-end environment of pharmacy claims processes including point of sale adjudication, accumulation processes, and claim reprocessing

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

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you’ll find a far-reaching choice of benefits and incentives. The hourly pay for this role will range from $28.27 to $50.48 per hour based on full-time employment. We comply with all minimum wage laws as applicable.

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.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

UnitedHealth Group is a drug – free workplace. Candidates are required to pass a drug test before beginning employment.