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Eligibility Analyst - Telecommute

Company: UnitedHealth Group
Location: Schaumburg
Posted on: June 21, 2022

Job Description:

Optum is a company that's on the rise. We're expanding in multiple directions, across borders and, most of all, in the way we think. Here, innovation isn't about another gadget, it's about transforming the health care industry. Ready to make a difference? Make yourself at home with us and start doing your life's best work.(sm) -You'll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.Primary Responsibilities:

  • Reviews eligibility data from clients to ensure accuracy of transmitted information. Recommends changes or corrections to client files or OptumRx eligibility fields with the claims system
  • Works with client to coordinate method of data transmission to the OptumRx Production Systems department for file loading
  • Ensures group / plan structure determinations are entered accurately and timely so that benefits and enrollment can be loaded into the OptumRx system properly. Provides quality assurance checks to ensure all fields are complete and able to be processed in the OptumRx claims system
  • Attends implementation meetings with clients and OptumRx staff to discuss eligibility requirements and protocols. Recommends eligibility file formats to clients and coordinates the receipt and processing of eligibility data
  • Maintains published timelines for receiving and processing client eligibility information and communicates targets to OptumRx staff and clients. Coordinates with client to ensure the timely receipt and processing of eligibility data
  • Analyzes eligibility reports, and researches and resolves discrepancies, errors, and problems to ensure that all claims are accurately processed with respect to eligibility data, and that all new plans are implemented according to established OptumRx and client guidelines
  • Coordinates with Implementation group to determine proper client hierarchy for client billing and reporting
  • Acts as liaison between client and OptumRx to coordinate receipt of required prescriber information for reporting and claim adjudication process for new and existing plansYou'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:
    • HS Diploma or GED
    • 1+ years of experience working with internal and external clients
    • 1+ years of experience working in the PBM industry
    • Experience working with various data file layouts, transferring data files, and translating file formats
    • Experience managing multiple priorities in a fast-paced business environment where adherence to strict processes and deadline
    • Intermediate or better proficiency using MS Office Suite (Excel, Word, Outlook, etc.)
    • Proven ability to provide client consultation and facilitate client meetings over the phone and face-to-face
    • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodationPreferred Qualifcations:
      • Bachelor's degree in Business, Finance, Economics, or related
      • 5+ years of experience working in the PBM industry
      • 1+ years of experience working in eligibility within the PBM industry
      • RxClaim platform experience
      • Medicare Part-D experience -
      • Experience using MS Visio and MS Project
      • Excellent communication, time/project management, problem solving, organizational, and analytical skills
      • Team player - able to build solid relationships with internal business partners and external clients
      • Meticulous and high level of attention to detailTo protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employmentCareers with OptumRx. We're one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. Here you'll fill far more than prescriptions. As a member of one of our pharmacy teams, you're empowered to be your best and do whatever it takes to help each customer. You'll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There's no better place to help people live healthier lives while doing your life's best work.(sm)Colorado, Connecticut or Nevada Residents Only: The hourly range for Colorado residents is $21.68 to $38.56. The hourly range for Connecticut / Nevada residents is $23.94 to $42.40. Pay is based on several factors including but not limited to education, work experience, certifications, etc. 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.*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.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: UnitedHealth Group, Schaumburg , Eligibility Analyst - Telecommute, Professions , Schaumburg, Illinois

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