|Courtesy of UnitedHealth Group|
OPPORTUNITY FOR BENEFITS ANALYSTS
UnitedHealth Group is working to create the health care system of tomorrow.
"Already Fortune 25, we are totally focused on innovation and change. We work a little harder. We aim a little higher. We expect more from ourselves and each other. And at the end of the day, we’re doing a lot of good.
Through our family of businesses and a lot of inspired individuals, we’re building a high-performance health care system that works better for more people in more ways than ever. Now we’re looking to reinforce our team with people who are decisive, brilliant – and built for speed." - UnitedHealth Group
• Analyze benefit requests and secure all necessary data to ensure appropriate. implementation based on applied logic of RxCLAIM (by SXC) pharmacy claim adjudication system.
• Work with Client Management 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.
• Ensure timely communication of any issues and/or information needed to complete a plan request.
• Develop client specific implementation plans and manage implementation processes in accordance with department protocol.
• Run queries out of the RxCLAIM adjudication system to secure all necessary information to implement plan requests.
• Develop and run macros in RxCLAIM to implement plan requests.
• Perform claim testing to ensure accurate claim adjudication.
• Maintain acceptable and appropriate quality levels and production turn around 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 Management, Clinical, and other internal department.
• Participate in team meetings.
• May be assigned to work on special projects and business initiatives.
• Bachelor's Degree in Pharmacy Graduate
• Registered Pharmacist
• Any related experience, BPO preferred
• Good communication skills, verbal and written.
• Experience in using MS Windows based PC skills (Word, Excel, Outlook)
• Understanding of basic medical terminology.
For interested applicants, please email your resume to Dearden Santiago (Recruiter) at Dearden_Santiago@uhgrecruitmentservices.com or you can walk in at UHG Science Hub Tower 1, Campus Avenue corner Turin Street, McKinley, Taguig CIty every Mondays and Wednesdays 10 am to 5 pm. You may also call the contact person at (+632)588-3286.
Source: UnitedHealth Group
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