Enroll Quality

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing **your life's best work.(sm)**

**Primary Responsibilities**:

- Review completed projects for accurate implementation based on requests received and applied logic of RxCLAIM;
- Perform test claims (as applicable) and document results to ensure requests were completed accurately in the system;
- Perform root cause analysis of errors identified (if applicable);
- Assess and communicate financial impact of the errors identified Operations (if applicable);
- Validate audit findings with affected parties and confirm corrected (if applicable);
- Recommend solutions to mitigate/fix the errors noted and review them with affected parties for an agreed upon approach, as appropriate
- Document work performed and audit results based on pre-determined standards and guidelines
- User Acceptance Testing (UAT) is preformed to ensure system changes and/or enhancements are properly tested and acceptable prior to implementation
- Work with Client Management to review the implemented new and maintain existing benefits and client pricing in the pharmacy claim adjudication system
- Ensure timely communication of any issues and/or information needed to complete a plan request
- Run queries out of the RxCLAIM adjudication system to secure all necessary information to implement plan requests
- Maintain acceptable and appropriate quality levels and production turnaround times
- Adhere to all documentation standards within the department
- Assist with the development of process improvements for the department
- Research and respond to all claims processing inquiries from Client
- 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

**Job Scope**:

- Applies knowledge/skills to complex activities
- Often acts as a technical resource to others in own function
- Anticipates customer needs and proactively identifies solutions
- Solves complex problems on own; proactively identifies new solutions to problems
- Plans, prioritizes, organizes and completes work to meet established objectives
- Acts as a facilitator to resolve conflicts on team; seen as key team member on project teams spanning more than own function

**Required Qualifications**:

- Bachelor's Degree
- 6+ months experience in retail pharmacy / BPO is preferred
- Microsoft Office proficiency Word and Excel, specifically Advanced Excel skills - must have ability to create Excel spreadsheet, macros, compile/analyze data for reporting
- Strong written and verbal skills
- Detail-oriented
- Superior organization skills
- Ability to work on multiple projects simultaneously
- Excellent analytical skills
- Flexible to work in Night shifts

**Careers with Optum. **Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do **your life's best work.(sm)