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Pharmancy Benefits Business Analyst - Schaumburg, IL

UnitedHealth Group

Schaumburg, IL
Job Code:
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Job Details

Pharmancy Benefits Business Analyst - Schaumburg, IL(Job Number:728710)

This position will be part of the Medicare Operations organization. This group is focused on verifying the correct processing of prescription drug claims, both paid and rejected. In this role, you will assist with the creation, implementation, and maintenance of Medicare Part D, formularies, build ad hoc queries in internal reporting system, interacts daily with internal / external partners and clients to provide ongoing support and issue resolution related to formularies, supports the Formulary team with drug list research, coding verification, list builds, and list extract requests and respond to requests regarding formulary products and services from all internal / external stakeholders.


To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.



Primary Responsibilities:

  • Reviewing paid and rejected Medicare prescription drug claims to determine appropriateness of payment and document describing findings

  • Assist with development and maintenance of Medicare Part D, formularies

  • Communicate with clinical account managers to facilitate updates to client custom formularies

  • Participate in all formulary management activities

  • Produce required reports to internal partners and clients in required formats in an accurate and timely fashion

  • Facilitate or assist with the member communications process

  • Assist with all aspects of formulary - related clinical programs

  • Continuously look for ways to streamline and improve the quality of the formulary management process

  • Support Audit, both internal and external

  • Perform other duties as necessary to meet the objectives of Optum and supporting clients and / or COE objectives

Job Business Analysis
Primary Location US-IL-Schaumburg
Other Location 
Organization OptumRx Formulary Ops
Schedule Full-time
Number of Openings 1
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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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