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Financial Analyst (Network Repricing)

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Job Description

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.


We all can agree that the quality of health care is marching forward and upward with great momentum. But it's not just quality of care. The entire system is becoming more efficient and effective thanks to companies like UnitedHealth Group and people like you. Here's your opportunity to combine expertise and compassion in new ways as you strike the balance between health care costs and resources. In this role, you'll ensure that health care contracts are priced accurately and fairly for all involved. As you do, you'll discover the impact you want and the resources, backing and opportunities that you'd expect from a Fortune 5 leader.


Primary Responsibilities:

  • Analyze and re-price existing client claims data to support client specific data analytics using SQL server, Netezza databases
  • Prepare requisite competitive (i.e., external) and internal historical claims data for use in the development of RFP response submission activities
  • Utilize relational database tools to re-price/trial adjudicate pharmacy claims
  • Validate source data and interpret/QA re-price/trial adjudication and summary and detail report results
  • Analyze source historical claims data for anomalies and/or trends in drug utilization patterns and costs
  • Develop and/or analyze and refine existing analytical models, and database queries as appropriate
  • Conduct financial and network pricing modeling, analysis and reporting
  • This opportunity is all about complexity. A dynamic marketplace means that unit cost forecasting will always be a challenge as costs continue to change. You'll be expected to monitor, analyze and incorporate those changes in reporting packages and relay them through finance to pricing and underwriting
  • Comply with the terms and conditions of the employment contract, company policies and procedures, and any and all directives (such as, but not limited to, transfer and/or re-assignment to different work locations, change in teams and/or work shifts, policies in regards to flexibility of work benefits and/or work environment, alternative work arrangements, and other decisions that may arise due to the changing business environment). The Company may adopt, vary or rescind these policies and directives in its absolute discretion and without any limitation (implied or otherwise) on its ability to do so

Required Qualifications:

  • Undergraduate degree or equivalent experience
  • Analytical experience in data analysis
  • Experience of writing complex SQL, PL/SQL queries for Data Analysis & Reconciliation
  • Intermediate level of proficiency in MS Excel
  • Intermediate SQL or other relational database solution experience


Preferred Qualifications:

  • Analytical experience in data analysis, health care pricing, network management, healthcare economics or related discipline
  • PBM experience
  • Python, R for Analytical Model Development

About Company

Optum, Inc. is an American pharmacy benefit manager and health care provider. It is a subsidiary of UnitedHealth Group since 2011. UHG formed Optum by merging its existing pharmacy and care delivery services into the single Optum brand, comprising three main businesses: OptumHealth, OptumInsight and OptumRx.In 2017, Optum accounted for 44 percent of UnitedHealth Group's profits and as of 2019, Optum's revenues have surpassed $100 billion.Also in early 2019, Optum gained significant media attention regarding a trade secrets lawsuit that the company filed against former executive David William Smith, after Smith left Optum to join Haven, the joint healthcare venture of Amazon, JPMorgan Chase, and Berkshire Hathaway.

Job ID: 139270315