PBM Claims System Liaison - Nashville, TN

UHG Nashville, TN

About the Job

Energize your career with one of Healthcare’s fastest growing companies.  


You dream of a great career with a great company – where you can make an impact and help people.  We dream of giving you the opportunity to do just this.  And with the incredible growth of our business, it’s a dream that definitely can come true. Already one of the world’s leading Healthcare companies, UnitedHealth Group is restlessly pursuing new ways to operate our service centers, improve our service levels and help people lead healthier lives.  We live for the opportunity to make a difference and right now, we are living it up.


This opportunity is with one of our most exciting business areas: Optum – a growing part of our family of companies that make UnitedHealth Group a Fortune 6 leader.


Optum helps nearly 60 million Americans live their lives to the fullest by educating them about their symptoms, conditions and treatments; helping them to navigate the system, finance their healthcare needs and stay on track with their health goals. No other business touches so many lives in such a positive way. And we do it all with every action focused on our shared values of Integrity, Compassion, Relationships, Innovation & Performance.

Welcome to one of the toughest and most fulfilling ways to help people, including yourself. We offer the latest tools, most intensive training program in the industry and nearly limitless opportunities for advancement. Join us and start doing your life's best work.

Primary Responsibilities: 
  • Plan and front end code edits to the claims processing system that provide services to the TennCare, CoverRx and CoverKids PBM Programs
  • Test new programs or modules to be used to manage Health Care Finance and Administration’s (HCFA) PBM Programs
  • Quality control of edits to ensure proper functioning within the system
  • Responsible for the maintenance and management of the PBM website for HCFA
  • Perform capacity planning and reporting 
  • Claims related and business system analysis 
  • Responsible for all aspects of quality assurance 
  • Create and edit requirements, specifications, cost benefit analysis and recommendations to proposed solutions 
  • Facilitate development of process documentation 
  • Generally, work is self - directed and not prescribed
  • Work with less structured, more complex issues
  • Serve as a resource to others
This particular position is for the: 
  • State of Tennessee
  • Department of Finance and Administration
  • Division of Health Care Finance and Administration
  • Bureau of TennCare
  • Request for Proposals for Pharmacy Benefit Management

Required Qualifications:
  • High School Diploma / GED (or higher)
  • 4+ years of experience analyzing and solving customer problems in an office setting environment using the telephone, computer and face - to - face discussions as the primary instruments to perform job duties 
  • Proficiency with computer and Windows PC applications, which includes the ability to learn new and complex computer system applications
Preferred Qualifications:
  • Bachelor’s Degree (or higher)
  • Fee for Service Medicaid or Medicaid Managed Care experience
  • PBM experience
  • Implementation experience
  • Client facing or account management experience
Physical Requirements and Work Environment: 
  • Extended periods of sitting at a computer and use of hands / fingers across keyboard or mouse
  • Office environment
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.

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 healthcare 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. Join us and start doing your life’s best work.

Diversity creates a healthier atmosphere: UnitedHealth Group is an Equal Employment Opportunity / Affirmative Action 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.

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

Keywords: OptumRx, Client Liaison, TennCare, CoverRx, CoverKids, PBM Program, Nashville, TN