Senior Manager - Network Pricing

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.

A Repricing Analyst focuses on analyzing and repricing of pharmacy claims to ensure accurate cost management. This role will work on pricing applications and projects related to the manipulation and analysis of data in support of a variety of analytic solutions.

Primary Responsibilities:

• Analyze and re-price existing client claims data to support client-specific data analytics using SQL server database
• Prepare competitive external and internal historical claims data for use in the development of RFP response submission activities
• Use relational database tools to re-price/trial adjudicate pharmacy claims
• Validate source data and interpret re-price/QA/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
• Work closely with internal teams, including finance, Accounting, and Sales, to ensure accurate and efficient claim processing
• Keep detailed records of all pricing adjustments and ensure compliance with all relevant regulations and policies
• 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

Skills and Abilities:

• Ability to analyze complex data and identify trends and discrepancies
• Ensure accuracy in all aspects of claim analysis and pricing adjustments
• Communicate clearly and effectively with team members and stakeholders
• Understanding of PBM processes, regulations, and industry standards
• Solid skills in SQL and relational database tools

Required Qualifications:

• 10+ years of analytical experience in financial analysis, PBM healthcare pricing, Network pricing or related discipline
• 6+ years of experience with SQL Server or other relational database solutions
• Experience in writing Complex SQL/PLSQL queries for data analysis and reconciliation
• Analytical experience in data analysis
• Advanced level of proficiency in MS Excel

Preferred Qualifications:

• Undergraduate degree
• SQL Server Azure experience
• Technical writing