Job: PBM Account Manager Client Relations, Optum RX - Irvine, CA or Richardson, TX
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This position is responsible for operations between OptumRx and UHC, UHC Affiliates and Acquired Entities. This position interacts with multiple layers of management to ensure responses related to operational issues are accurate, completed on time and within scope, as well as oversee implementation or improvement of new or existing connections.
Manages ongoing contract relationships and service delivery to clients for one or more accounts. Acts as outward-facing, dedicated resource for assigned accounts, typically with direct client contact (not call center) and large or complex accounts. Builds relationships with employer/group clients (not individual members) and serves as the primary point of contact for overall and day-to-day service delivery. Represents client internally and coordinates with other functions to implement client systems, complete projects, and address ongoing service needs. This function includes employees who are in dedicated on-site service roles. Jobs in this function may work closely with sales on renewals and upselling, but incumbents do not have specific sales goal accountability or primary responsibility to close sales. Account management jobs focused primarily on relationship and service management belong in this family; jobs with significant sales responsibilities or sales-related incentives (including 'OTH' plans) belong in a sales band.
Primary Responsibilities:Conduct Eligibility ReconciliationConduct Accumulator ReconciliationOversee Mass AdjustmentsSupport operational training on PBM systems such as RxClaim, IFMS, PAS, RxExpress /IRIS and Online Reporting Tool.Support the creation, maintenance and organization of SOP's, P&P and business process flows Support File Feed Set up and MaintenanceSupport DMHC / NCQA / URAC and other client audit activitiesSupport Health Care Reform ImplementationsSupport Regulatory ReportingManage process for Appeals / Grievance reviewsSupport implementation of new pharmacy products / servicesIdentify trends, document lessons learned and drive continuous service / client or customer process improvement.Represent OptumRx to UHC Operations Teams (PRIME, ACIS, CDB, TOPS, CAMS)Provide support to the Client Service and Account Service Teams in the management of member and customer specific escalated issues and/or service concernsAct as SME for pharmacy benefit design, products, and programs Provider support to Client Management Teams for on-boarding of new team membersServe as trainer to Client Management Teams on UHC, UHC Affiliate and Acquired Entity pharmacy plans and operationsAnalyzes and investigates.Provides explanations and interpretations within area of expertise.
High School Diploma/GED with 5+ years working in PBM OR a Bachelors degree 2+ years of PBM experience is requiredIntermediate in Microsoft Word, Excel & PowerPoint
Microsoft Project and Access experience is a plus
Project management experience is preferred
OptumRx is part of the family of companies that make UnitedHealth Group one of the leaders across most major segments of the US health care system. If you're ready to talk about groundbreaking interactions, let's talk about what happens when a firm that touches millions of lives decides to gather results from millions of prescriptions every month and analyze their impact. Let's talk about smart, motivated teams. Let's talk about more effective and affordable health care solutions. This is caring. This is great chemistry. This is the way to make a difference. We're doing all this, and more, through a greater dedication to our shared values of integrity, compassion, relationships, innovation and performance. OptumRx is an empowering place for people with the flexibility to help create change. Innovation is part of the job description. And passion for improving the lives of our customers is a motivating factor in everything we do. In the largest and most personal sense, your impact can be greater than even you thought at OptumRx.Diversity creates a healthier atmosphere: equal opportunity employer M/F/D/VUnitedHealth Group is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. In addition, employees in certain positions are subject to random drug testing.
Skills / Requirements