Senior Financial Claims Analyst - Pharmacy or Benefits

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, strong personal work ethic and the ability to manage time to meet deadlines. Strong task prioritization skills and critical thinking skills are a must!

Success in this role will require the following:

• Detail oriented (specifically focused on data accuracy and presentation)
• Ability to manage time efficiently and prioritize effectively to adhere to deadlines
• Ability to multitask in a dynamic setting, flexible to changes, and maintain focus under pressure
• Strong organizational skills to track requests and deliverables
• Must be pro-active and have good problem-solving skills
• Ability to work both independently and within a team setting
• Ability to learn quickly and desire to take on new challenges
• Strong desire to make continuous improvements in all areas of responsibility
• Ability to follow-through, be resourceful and self-driven

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

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

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