business operations analyst - Muntinlupa city, ncrUnitedHealth Group

Combine two of the fastest-growing fields on the planet with a culture of performance, collaboration and opportunity and this is what you get. Leading edge technology in an industry that's improving the lives of millions. Here, innovation isn't about another gadget, it's about making health care data available wherever and whenever people need it, safely and reliably. There's no room for error. Join us and start doing your life's best work.(sm)
We'll put you in the driver's seat on vital projects that have strategic importance to our mission of helping people lead healthier lives. Yes, we share a mission that inspires. We need your organizational talents and business discipline to help fuel ours. It's the opportunity to do your life's best work.(sm)
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.
Positions in this function include those responsible for providing process and operational support to the functions within Business Operations Family. Positions in this function may also be responsible for quality reporting, analysis and audits, and for developing plans and programs to support continuous quality improvement using applicable tools. *Employees in jobs labeled with 'SCA' must support a government Service Contract Act (SCA) agreement. Work does not usually require established procedures.
Core Competencies:
Strong writing and documentation skills
Organizational skills
Creativity
Primary Responsibilities:
Mentors others
Acts as a resource for others
Coordinates others' activities
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
Eligibility
To apply to an internal job, employees must meet the following criteria:
Must have no Active CAP/PIP
Must have at least 12 months in current role/tenure
Required Qualifications:
Research experience in AS400/RxClaim
Extensive work experience, possibly in multiple functions
Basic proficiency in MS/Office (Word and Excel)
Ability to work independently
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)
Careers with Optum. Here's the idea. We built an entire organization around one giant objective; make health care work better for everyone. So when it comes to how we use the world's large accumulation of health-related information, or guide health and lifestyle choices or manage pharmacy benefits for millions, our first goal is to leap beyond the status quo and uncover new ways to serve. Optum, part of the UnitedHealth Group family of businesses, brings together some of the greatest minds and most advanced ideas on where health care has to go in order to reach its fullest potential. For you, that means working on high performance teams against sophisticated challenges that matter. Optum, incredible ideas in one incredible company and a singular opportunity to do your life's best work.(sm)
Diversity creates a healthier atmosphere: Optum 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.
Optum is a drug-free workplace. © 2022 Optum Global Solutions (Philippines) Inc. All rights reserved.
UnitedHealth Group

Alabang, Muntinlupa City
Permanent
Full-time