Skip to main content

Medicare Formulary Business Analyst - Philadelphia, PA or Schaumburg, IL

Position Description

This position will be part of the Medicare Operations organization. This group is focused on verifying the correct processing of prescription drug claims, both paid and rejected. In this role, you will assist with the creation, implementation, and maintenance of Medicare Part D, formularies, build ad hoc queries in internal reporting system, interacts daily with internal / external partners and clients to provide ongoing support and issue resolution related to formularies, supports the Formulary team with drug list research, coding verification, list builds, and list extract requests and respond to requests regarding formulary products and services from all internal / external stakeholders.

To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed below are representative of the knowledge, skill, and / or ability required. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.

Primary Responsibilities:

  • Reviewing paid and rejected Medicare prescription drug claims to determine appropriateness of payment and document describing findings
  • Assist with development and maintenance of Medicare Part D, formularies
  • Communicate with clinical account managers to facilitate updates to client custom formularies
  • Participate in all formulary management activities
  • Produce required reports to internal partners and clients in required formats in an accurate and timely fashion
  • Facilitate or assist with the member communications process
  • Assist with all aspects of formulary - related clinical programs
  • Continuously look for ways to streamline and improve the quality of the formulary management process
  • Support Audit, both internal and external
  • Perform other duties as necessary to meet the objectives of Optum and supporting clients and / or COE objectives



Required Qualifications:

  • 2+ years of experience in Pharmacy Benefits Management or managed care settings
  • Working knowledge of MediSpan data system including GPI drug classification system. First Data Bank experience accepted
  • Familiarity with prescription benefit, formulary and clinical program design
  • Intermediate ability in Excel


Preferred Qualifications:

  • Bachelor's degree
  • Pharmacy technician licensure or comparable experience
  • Working knowledge of Medicare Part D regulations and experience
  • Previous formulary management experience
  • Knowledge of MS Access
  • Excellent verbal and written communication skills
  • Demonstrated ability to work collaboratively in a team environment
  • Excellent interpersonal and problem - solving skills
  • Strong customer service orientation and commitment to professionalism



Careers with OptumRx. We're one of the largest and most innovative pharmacy benefits managers in the US, serving more than 12 million people nationwide. Here you'll fill far more than prescriptions. As a member of one of our pharmacy teams, you're empowered to be your best and do whatever it takes to help each customer. You'll find unrivaled support and training as well as a wealth of growth and development opportunities driven by your performance and limited only by your imagination. Join us. There's no better place to help people live healthier lives while doing your life's best work.(sm)

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.

Job Keywords: Pharmacy Benefits Management, Schaumburg, IL, Illinois, Philadelphia, PA, Pennsylvania

Medicare Formulary Business Analyst - Philadelphia, PA or Schaumburg, IL

Philadelphia, PA
Full Time

Published on 06/06/2019