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Associate Pharmacy Benefit Implementation Analyst - Wausau, WI

UnitedHealth Group

Wausau, WI
Job Code:
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Job Details

Associate Pharmacy Benefit Implementation Analyst - Wausau, WI(Job Number:729975)

Position Description:

Energize your career with one of Healthcare’s fastest growing companies.  


You dream of a great career with a great company – where you can make an impact and help people.  We dream of giving you the opportunity to do just this.  And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives.  We live for the opportunity to make a difference and right now, we are living it up.


This opportunity is with one of our most exciting business areas: Optum –a growing part of our family of companies that make UnitedHealth Group a Fortune 17 leader.


Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.

An Associate Pharmacy Benefit Implementation Analyst will play a critical role in creating a quality member experience by accurately implementing and revising assigned pharmacy benefit plans and will be responsible for constructing and revising prescription plans cost and coverage levels in alignment with the client’s predetermined requirements. Assets needed for an Associate Pharmacy Benefit Implementation Analyst are but not limited to; a high degree of personal accountability, detail oriented, and have the ability to analyze and solve complex problems with excellent conflict resolutions skills. Necessities for this position include; strong written and verbal skills, superior organizational skills, thinking outside of the box capabilities, and the ability to work on multiple projects simultaneously and prioritize accordingly.

Primary Responsibilities:

  • Analyze benefit requests and secure all necessary data to ensure appropriate implementation based on applied logic of RxCLAIM pharmacy claim adjudication system

    • Work with other cross-functional departments to implement new and maintain existing benefit plans and client pricing in the pharmacy claim adjudication system

    • Work with Clinical Pharmacy to implement formulary updates and clinical programs in the pharmacy claim adjudication system

    • Work with Pharmacy Network Management to implement pharmacy rate changes and network additions in the pharmacy claim adjudication system

  • Research and respond to all claims processing inquiries from Client Management, Clinical, and other OptumRx internal departments

  • Perform claim testing to ensure accurate claim adjudication

  • Run queries out of the RxCLAIM adjudication system to secure all necessary information to implement plan requests

  • Self-motivated to accomplish assigned tasks

  • Ability to work independently to maintain acceptable quality levels including timely communications of any issues and / or required information in order to complete plan requests within production turnaround time guidelines.

  • Utilize macros in RxCLAIM™ to implement plan requests.

  • Participate in team meetings

  • Perform other duties as assigned

Job Empl Contract Install & Implem
Primary Location US-WI-Wausau
Other Location 
Organization OptumRx Claims Operations
Schedule Full-time
Number of Openings 1
Apply on the Company Site

UnitedHealth Group is the most diversified health care company in the United States and a leader worldwide in helping people live healthier lives and helping to make the health system work better for everyone.

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