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 diversity and inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.

This Business Operations Specialist position is required to handle increased workload associated with Prior Authorization system setup. The Prior Authorization system setup includes the loading of letters, updating of tables, loading clinical guidelines, and updating automated decision trees.

This role is vital since without it we will risk incomplete guidelines, incomplete or incorrect approval and denial letters loaded for each client for each migration resulting in increased cost to client and decreased member satisfaction.

Primary Responsibility:

• 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:

• High School Diploma/GED
• Basic proficiency in MS/Office (Word and Excel)
• Research experience in AS400/Rx Claim

Preferred Qualifications:

• Bachelor's degree
• Pharmacy Claims experience
• Pharmacy Help Desk or RCR knowledge
• Well-rounded business knowledge including standard prior authorization process
• Well-rounded knowledge of the Pega or Pega Rules Process Commander (PRPC) application
• Knowledge of Center for Medicare Services (CMS) Regulations
• Knowledge of Prior Authorization Case turnaround times (TAT)

Core Competencies:

• Solid writing and documentation skills
• Organizational skills
• Creativity

At United Health 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.

Diversity creates a healthier atmosphere: Optum is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

Optum is a drug-free workplace. © 2024 Optum Global Solutions (Philippines) Inc. All rights reserved.