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.
Primary Responsibilities:
- Responds effectively and efficiently to urgent member needs and demonstrates professionalism in this environment
- Understands and supports regimen of sequence to prioritize medication
- Exercises positive team collaboration across all PBM functions to ensure order timeliness and supports quality and service metric achievement
- Performs other duties as assigned and within scope of practice
- Analyze the requests and secure all necessary data to ensure appropriate
- Carrying out and utilizing all relevant policies, procedures, work instructions and forms to facilitate the efficient operation of the assigned task(s)
- Ensure timely communication of any issues and/or information needed
- Perform claim testing to ensure accurate claim adjudication
- Adhere to all documentation standards within the department
- Assist with the development of process improvements for the department
- Adherence to company attendance policy
- Complete assigned work on time
- 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 regard 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
JOB Scope:
- Applies knowledge/skills to complex activities
- Demonstrates a depth and breadth of knowledge/skills in own area and is often able to apply these outside of own function
- Anticipates customer needs and proactively identifies solutions
- Solves complex problems on own
- Plans, prioritizes, organizes, and completes work to meet established objectives
Performance Standard:
- Ability to maintain an accuracy rate of 99.85% or better
- Able to work independently
- Completes assigned projects on time
Required Qualifications:
- 3+ years of experience in insurance and health care domain
- Pharmacy benefit management and RxClaim application working experience
- Should have manual claims processing experience
- Should be ready to work all 5 days from office
- Should have solid insurance background
- Pharmacy benefit management and RxClaim application working experience
- Should be Flexible with night shifts
- Skills:
- Microsoft Office proficiency Word and Excel, specifically Advanced Excel skills -- must have ability to create Excel spreadsheet, macros, compile/analyze data for reporting
- Solid written and verbal skills
- Proven detail-oriented
- Ability to Multi-task
- Proven excellent analytical skills
- Shift Flexibility
- Proficient computer and organizational skills with the ability to focus on workload and achievement of both production and quality objective
