A Repricing Analyst focuses on analyzing and repricing of pharmacy claims to ensure accurate cost management. This role will work on pricing applications and projects related to the manipulation and analysis of data in support of a variety of analytic solutions.
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Primary Responsibilities:
- Analyze and re-price existing client claims data to support client-specific data analytics using SQL server database
- Prepare competitive external and internal historical claims data for use in the development of RFP response submission activities
- Use relational database tools to re-price/trial adjudicate pharmacy claims
- Validate source data and interpret re-price/QA/trial adjudication and summary and detail report results
- Analyze source historical claims data for anomalies and/or trends in drug utilization patterns and costs
- Develop and/or analyze and refine existing analytical models and database queries as appropriate
- Conduct financial and network pricing modeling, analysis, and reporting
- Work closely with internal teams, including finance, Accounting, and Sales, to ensure accurate and efficient claim processing
- Keep detailed records of all pricing adjustments and ensure compliance with all relevant regulations and policies
- 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
Skills and Abilities:
- Ability to analyze complex data and identify trends and discrepancies
- Ensure accuracy in all aspects of claim analysis and pricing adjustments
- Communicate clearly and effectively with team members and stakeholders
- Understanding of PBM processes, regulations, and industry standards
- Solid skills in SQL and relational database tools
Required Qualifications:
- 8+ years of analytical experience in financial analysis, PBM healthcare pricing, Network pricing or related discipline
- 4+ years of experience with SQL Server or other relational database solutions
- Experience in writing Complex SQL/PLSQL queries for data analysis and reconciliation
- Analytical experience in data analysis
- Advanced level of proficiency in MS Excel
Preferred Qualifications:
- Undergraduate degree
- SQL Server Azure experience
- Technical writing
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.
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What We Do
We’re the health care technology and innovation company of the UnitedHealth Group enterprise along with UnitedHealthcare. We’re a global organization that’s evolving health care so everyone can have the opportunity to live their healthiest life. With our hands across all aspects of health, we'll provide you with a rewarding career that enables you to grow in the directions that best fit your passions. This is your opportunity to be part of a team that’s dedicated to Caring. Connecting. Growing together.
Our global technology team consists of more than 30,000 innovators from around the world passionate about using technology to improve the lives of people and communities. We are modernizing the health care system through modern analytics, comprehensive clinical expertise, innovative technologies and extensive experience in improving operational and clinical performance.
As part of our team, you will be provided opportunities to channel your curiosity into initiative, working alongside distinguished engineers and developers pursuing innovations that improve the health care experience for everyone. We encourage you to dive in, explore and ask questions about creative ways to use technology to help make the health care system work like an actual system.
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Employees engage in a combination of remote and on-site work.
Optum has three workplace models that balance the needs of the business, the responsibilities of a job, and your preference for more flexibility. These models are core on-site 5 days/week, hybrid 3 day/s week and telecommute or fully remote.
