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.
Position Schedule: Monday through Friday between the hours of 6:00AM-5:00PM PST, 40 hours per week
Primary Responsibilities
- Monitor and review recent pharmacy claims for potential waste, abuse and errors
- Perform reviews of pharmacy claims for accurate submissions through either telephonic or electronic outreaches
- Apply knowledge of pharmacy practice, data mining techniques, and drug knowledge to evaluate if billing is appropriate
- Perform calculations to assess accuracy of billing
- Document results of findings from the concurrent review
- Assist in the creation and maintenance of job aids
- Train new auditors, handle special projects, provide team support and perform internal peer quality audits
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
- Current and unrestricted Pharmacy Tech License in state of residence
- Current and active National Pharmacy Technician Certification (ExCPT or PTCB)
- 2+ years of experience as a Pharmacy Technician in a retail pharmacy, PBM, or specialized pharmacy
- 1+ years of experience with pharmacy claims audits
- 1+ years of experience with RxClaim and Integrated Data Warehouse
- Willing and able to work within the hours of 6:00AM-5:00PM PST
Preferred Qualifications
- Principles of Effective Training (POET) certified facilitator
- 2+ years of experience in Microsoft Word (creating/updating documents) and Microsoft Excel (creating/updating spreadsheets, pivot tables, and formulas
Soft Skills
- Proven solid communication skills
- All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Washington, or Washington D.C Residents Only: The salary range for California, Colorado, Nevada, Connecticut, New York, New Jersey, Rhode Island, Hawaii, Washington, or Washington D.C residents is $48,300 to $94,500 per year. 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.
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.
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.
#RPO #Green
