Senior Audit Analyst - Remote

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.

As a Senior Audit Analyst, you will be vital to our success in achieving the mission of the Client Audit Department to provide best-in-industry audit management services to our internal and external business partners. In addition, you will help strive to ensure Optum Rx is only paying out on confirmed errors to reduce our financial liability and to ensure corrections are made in a timely manner.

This position supports the facilitation of external audits mainly focused on validating the accuracy of pharmacy benefit plans, pricing guarantees, and rebate administration. This role requires interaction with both internal business partners at various levels of the organization and the external audit community to successfully complete audits.  Leveraging a well-established process, individuals in this role support our clients by responding to claim sets, audit reports, and generally being the liaison to the auditing entity.

Hours: Monday - Friday - 8 AM - 5 PM CST but can be flexible with the candidates' time zone

You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges.

Primary Responsibilities:

• Facilitate end-to-end management of external client audits focused mainly on validating the accuracy of pharmacy claim benefits, pricing guarantees, and rebate administration
• Support manufacturer billing rebate audits conducted virtually and, in some cases, physically on-site
• Request and obtain benefit, pricing, and rebate documentation from internal teams to provide to external audit firms within established turn-around times
• Read and interpret benefit design documents, pricing reconciliation reporting, and rebate reporting
• Research historical claims and plan design set-up in RxClaim and comparing to source of truth documentation to validate claims processed as expected
• Research historical claims to ensure they were accounted for correctly in the pricing guarantee and minimum rebate guarantee reconciliations
• Respond to claim sample inquiries and audit reports from external audit firms
• Actively participate in Department projects
• Consistently meet established productivity, deliverable timeline adherence, and Department quality standards

What are the reasons to consider working for UnitedHealth Group?  Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:

• Paid Time Off which you start to accrue with your first pay period plus 9 Paid Holidays
• Medical Plan options along with participation in a Health Spending Account or a Health Saving account
• Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
• 401(k) Savings Plan, Employee Stock Purchase Plan
• Education Reimbursement
• Employee Discounts
• Employee Assistance Program
• Employee Referral Bonus Program
• Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)

You'll be rewarded and recognized for your performance in an environment that will challenge you and give you clear directions on what it takes to succeed in your role as well as provide development for other roles you may be interested in.

Required Qualifications:

• High School Diploma/GED (or higher)
• 3+ years of experience in PBM, Medical Benefits and/or Claims Audit experience
• 3+ years of experience working in RxClaim or other similar claims adjudication system to research claims
• Intermediate level of project management experience
• Intermediate level of proficiency within Microsoft Office Suite (Excel, Word, PowerPoint). Must know how to use and apply formulas, filters, and sorting techniques in Excel
• Intermediate level of proficiency with written and verbal communications skills, including preparing, leading, and presenting in meetings with various levels of leadership on complex topics
• Intermediate level of ability to explain complex topics in a simplified manner for easy understanding
• Intermediate level of proficiency in effectively managing time, resources, and tasks to achieve hard deadlines
• Ability to change gears in a high paced, highly functional team
• Ability to Travel up to 10%

Preferred Qualification:

• Certified Pharmacy Technician
• Experience facilitating PBM audits, specifically pharmacy claim benefits, pricing guarantees, or rebate audits
• Experience working with upper leadership and presenting confidently on complex issues
• Experience leading projects lasting three months or longer
• Internal or Quality Auditing experience
• Ability to interpret contractual language and apply to pricing guarantees and rebates

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

At UnitedHealth Group, our mission is to help people live healthier lives and make the health system work better for everyone. We believe everyone-of every race, gender, sexuality, age, location, and income-deserves the opportunity to live their healthiest life. Today, however, there are still far too many barriers to good health which are disproportionately experienced by people of color, historically marginalized groups, and those with lower incomes. We are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes - an enterprise priority reflected in our mission.

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will rangefrom $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.

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