Grand Rapids and Muskegon, Michigan
Largo, Maryland
Baltimore, Maryland
Boise, Idaho
Posted: 16-Dec-24
Location: Eden Prairie, Minnesota
Categories:
Internal Number: 145230526
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.
As a Senior Internal Audit Analyst, you will be vital to our success in achieving the mission of the Commercial Client Audit (CCA) Department to provide best in industry audit management services to our internal and external business partners. In additional, you will help strive to ensure Optum Rx is only paying out on confirmed errors to reduce our financial liability and to ensure corrections are made in a timely manner.
This position supports the facilitation of external and internal audits mainly focused on commercial pharmacy benefit plans, pricing guarantees, and rebates were properly billed, collected, and disbursed to our clients. The role requires interaction with both internal business partners and the audit community to successfully complete audits. Leveraging a well-established process, individuals in this role support our clients by responding to claim sets, audit reports, and generally being the liaison to the auditing entity.
You’ll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.
Primary Responsibilities:
- Facilitate end-to-end management of external and internal client audits focused mainly on pharmacy claim benefits, pricing guarantees, and rebates
- Support manufacturer billing rebate audits, both on-site and virtual, at the direction of the lead auditor
- Request and obtain benefit, pricing, and rebate documentation from internal teams to provide to external audit firms within established turn-around times
- Read and interpret benefit design documents, pricing reconciliation reporting, and rebate reporting
- Research historical claims and plan design set-up in RxClaim and comparing to source of truth documentation to validate claims processed as expected
- Research historical claims to ensure they were accounted for correctly in the pricing guarantee and minimum rebate guarantee reconciliations
- Respond to claim sample inquires and audit reports from external audit firms
- Actively participate on Department projects
- Consistently meet established productivity, deliverable timeline adherence, and Department quality standards
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:
- Undergraduate degree or equivalent work experience
- 3+ years of experience working for a Pharmacy Benefit Manager (PBM) and/or PBM audit experience
- 1+ years of experience working in Optum Rx’s claims adjudication system RxClaim and/or experience researching adjudicated claims to ensure they processed correctly
- Intermediate proficiency (2 + years) experience in project management (e.g., effectively managing time, resources, and tasks to achieve hard deadlines)
- Experience & comfort level leading and presenting on complex topics to upper-level leadership
- Willingness to Travel up to 10%
Preferred Qualifications:
- Certified Pharmacy Technician
- Experience in interpreting contractual language
- Experience with Microsoft Excel
- Internal or Quality Auditing experience
- PBM audit experience, Claim Benefits, Pricing Guarantees or Rebate Audits
*All employees working remotely will be required to adhere to UnitedHealth Group’s Telecommuter Policy
California, Colorado, Connecticut, Hawaii, Maryland, Nevada, New Jersey, New York, Rhode Island, Washington, Washington, D.C. Residents Only: The salary range for this role is $58,300 to $114,300 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.
