UnitedHealth Group Associate Employer Installation Specialist - US Telecommute in Phoenix, Arizona

Energize your career with one of Healthcare’s fastest growing companies.

You dream of a great career with a great company - where you can make an impact and help people. We dream of giving you the opportunity to do just this. And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives. We live for the opportunity to make a difference and right now, we are living it up.

This opportunity is with one of our most exciting business areas: Optum - a growing part of our family of companies that make UnitedHealth Group a Fortune 6 leader.

Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation and Performance.

Working in Operations at UnitedHealth Group is one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work. SM

Position in this function are responsible for the installation of assigned accounts, including, but not limited to: structure building and billing set up, structure revisions, researching & resolving structure issues, database loading, and preparation of plan materials such as administrative documents and customer education materials. Positions are responsible for overall employer contract loading using various databases and / or source documents. May research installation issues & develop customer specific resolutions. May include auditing contract loads for adherence to quality measures and reporting standards.

Primary Responsibilities:

  • Audit contract loads for adherence to quality measures and reporting standards

  • Research errors by comparing Account Management documentation against multiple internal systems

  • Analyze and Research techniques to trend or quantify projects

  • Prepare, process, and maintain new group installation and renewals

  • Respond to member eligibility or group questions and verify enrollment status

  • Reconcile reports and group set up discrepancies, as well as analyzing transactional data and submitting retroactive eligibility changes

  • Research and respond to all claims processing inquiries from Client Management, Clinical, and other internal departments.

  • Perform claim testing to ensure accurate claim adjudication

  • Conduct installation of assigned accounts, including, but not limited to: structure building and billing set up, structure revisions, researching and resolving structure issues, database loading, and preparation of plan materials such as administrative documents and customer education material

  • Overall employer contract loading using various databases and / or source documents. May research installation issues & develop customer specific resolutions which may include auditing contract loads for adherence to quality measures and reporting standards

  • Perform other duties as assigned

  • Basic, structured, standard approach to work

Key Work and Accountabilities (Guidelines)

  • Develop decision trees (DTs) in RxAuth & Pega RXAUTH & PAS using plan specific clinical guideline criteria

  • Document testing of changes to or creation of DTs

  • Manage DT life cycle to ensure completion in accordance with deployment schedule

  • Work with RxAuth & RXAUTH & PAS IT support to overcome environmental challenges

  • Review client PA survey and ensure all key attributes exist for successful install

  • Maintain Pega RXAUTH & PAS decision & data tables for appropriate case processing

  • Triage RXAUTH & PAS Change Request, identify enhancement vs. biz rule update

  • Collaborate with RXAUTH & PAS dev team to provide solutions where possible

  • Work with RXAUTH & PAS IT support to overcome environmental challenges

Key Competencies / Capabilities needed to perform this role

  • Utilize and understand Pega RXAUTH & PAS business rule functionality to provide "business configurable" solutions

  • Able to identify system vs. user error

  • Listen to, understand, and anticipate solution

  • Critical thought process and analytical skills

  • Basic proficiency with MS Excel & Word

  • Ability to drive task to completion despite significant challenge (collaborate, communicate)

Required Qualifications:

  • High School Diploma / GED or higher

  • 1+ years of experience in a healthcare insurance environment using the telephone and computer as the primary instruments to perform job duties

  • 1+ year of experience in a PBM environment performing a benefit related function.

  • Proficiency with Windows PC applications, which includes the ability to navigate and learn new and complex computer system applications

  • Intermediate level of Microsoft Excel, must be able to navigate, create, open, a save a spreadsheet. Must have the ability to sort, filter, and search spreadsheets as well as create formulas.

  • Data Entry experience (45+ WPM)

  • Must be available to work a scheduled 8 hours shift within the hours of 8:00 - 5:00pm, Monday through Friday with the possibility of working overtime either before, after, or on a day other than your scheduled day.

Preferred Qualifications:

  • Ability to be flexible and work independently with minimal supervision as well as in a team setting within a constantly changing environment

  • Undergraduate degree or higher - pharmacy or healthcare fields

  • Pharmacy Technician and / or CPHT License

  • Quality assurance experience

  • Proficiency with MS Word, Access and PowerPoint

  • 5+ years of experience in a healthcare insurance environment using the telephone and computer as the primary instruments to perform job duties

  • 2+ year of experience in a PBM environment performing a benefit related function

  • Self-directed and the ability to prioritize caseloads based on business and customer needs

Soft Skills:

  • Ability to be flexible and work independently with minimal supervision as well as in a team setting within a constantly changing environment

  • Self - directed and the ability to prioritize caseloads based on business and customer needs

Physical Requirements and Work Environment:

  • Frequent speaking, listening using a headset, sitting, use of hands / fingers across keyboard or mouse, handling other objects, and long periods working at a computer

  • Service center environment with moderate noise level due to Representatives talking, computers, printers and floor activity

OptumRx is an empowering place for people with the flexibility to help create change. Innovation is part of the job description. And passion for improving the lives of our customers is a motivating factor in everything we do.

If you're ready to talk about groundbreaking interactions, let's talk about what happens when a firm that touches millions of lives decides to gather results from millions of prescriptions every month and analyze their impact. Let's talk about smart, motivated teams. Let's talk about more effective and affordable healthcare solutions. This is caring. This is great chemistry. This is the way to make a difference. We're doing all this, and more, through a greater dedication to our shared values of integrity, compassion, relationships, innovation and performance. Join us and start doing your life’s best work. SM

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.

Keywords: Prior auth, prior authorization, PBM, Pharmacy, pharmacy technician, RXAUTH, PAS, RXClaim, Sharepoint, Business Rules, PresPlus Share, NewLeaf, Optum, OptumRx, UnitedHealthcare, UnitedHealthcare Group