Senior Financial Claims Analyst – Pharmacy or Benefits

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.

We are searching for a Senior Financial Analyst (Client / Benefits) at OptumRx. This is an internal facing role, meaning you will be working directly with our operational partners. This position requires a high level of analytical skill and unique expertise of benefits. As a key resource, you must maintain a high degree of accuracy along with attention to detail, excellent oral and written communication skills, solid personal work ethic and the ability to manage time to meet deadlines. Solid task prioritization skills and critical thinking skills are a must!

Primary Responsibilities:

• Communicate and collaborate with our team
• Support client issue remediation by reviewing and analyzing pharmacy claims (calculating before and after scenarios)
• Review external auditor findings, for either agreement or disagreement
• Research, analyze, and evaluate claims data to identify patterns and validate accuracy
• Work closely with the client account team and other functional departments
• Provide explanations, interpretations, and recommendations for reporting results as needed
• Support various projects with financial impacts as needed
• 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

Required Qualifications:

• 3+ years of experience in an analytical role related to Finance, Claims, Pharmacy, or PBM
• 2+ years of experience analyzing large data sets (ie claims) to find patterns, errors, trends, anomalies (pharmacy, finance, or accounting preferred)
• Proven expertise in data scrubbing and manipulation to identify and resolve inconsistencies and anomalies with the ability to demonstrate before and after scenarios
• Proven solid Microsoft Excel Skills (e.g., complex conditional formulas, nested formulas, V-lookups, pivot tables, etc.)

Preferred Qualifications:

• Financial/Accounting/Remediation experience
• Experience with SQL: knowledge of tables and joins, writing query statements
• Experience with RxClaim
• Experience in Microsoft Access: create tables, queries, joins, data manipulation
• Knowledge of PBM and pharmacy benefit structure
• Proven to be self-directed, works with minimal guidance, but recognizes when guidance needed
• Proven excellent communication, time/project management, problem solving, organizational, and analytical skills