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Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data, and resources they need to feel their best. Here, you will find a culture guided by diversity and inclusion, talented peers, comprehensive benefits, and career development opportunities. Come make an impact on the communities we serve as you help us advance health equity on a global scale. Join us to start Caring. Connecting. Growing together.
The essential functions of a Senior Pharmacy PA/Appeals Technician are providing expertise and customer service support to members, customers, and/or providers. This position exists to take incoming requests for prior authorizations, for formulary and non-formulary medications, while ensuring a high level of customer service and maximizing productivity. Requests can be received via fax or telephone, from providers' offices and pharmacists. The position provides clinical review for authorizations in keeping with legal and contractual requirements, including but not limited to turn around times (TATs) and service level agreements (SLAs). The technician must provide the information clearly, accurately and in a professional manner. Interactions with callers must be documented per contractual and various regulatory / legal requirements.
Work Schedule: Monday - Friday, 8 hours between 8am - 6pm EST with rotational on call shifts for evenings/weekends every 5 weeks
If you reside in the state of Vermont, you'll have the flexibility to telecommute* as you take on some tough challenges.
Primary Responsibilities:
- Handling HelpDesk calls dealing with pharmacy claims rejections
- Training is for 4 weeks. Training time is 8:00am-5:00pm. Monday- Friday. This training time is subject to change
- Shift after training is an 8-hour shift with a 30 minute lunch. Candidate must be available as early as 8am and as late as 6pm
- Candidate will work 5 days a week which will include a Saturday shift (8am - 2pm) every 5th week
- Primarily answering prior authorization inquiry calls/requests with customer service as well as research and resolve formulary and benefit issues using the appropriate reference material
- Process member prescriptions or prior authorizations through various computer systems ensuring the accuracy of all data and updating as necessary
- Using established criteria and guidelines, the pharmacy technician receives and processes prior authorization requests made by providers and members for medications not inherently covered on a member's prescription drug plan
- Resolve issues and complaints in a timely manner
- Performs other duties as assigned by management
- Handles inbound phone requests and gathers member data to provide information for pharmacist consultations
- Safety is paramount and it's important for employees to have a safe and secure workspace and communicate with their leadership when that safety (equipment, system, information) is compromised
- There may be scheduled overtime and/or working on holidays dependent on business needs
- Candidate must have their own home internet access (internet can be hard wired with Ethernet cord)
- Candidate must also have a secure workspace/office in their home
- Candidate must have level skill with working with PC (ex. using mouse and keyboard, accessing, and navigating through multiple systems and screens)
- Excellent attendance is a must
What are the reasons to consider working for UnitedHealth Group? Put it all together - competitive base pay, a full and comprehensive benefit program, performance rewards, and a management team who demonstrates their commitment to your success. Some of our offerings include:
- Paid Time Off which you start to accrue with your first pay period plus 8 Paid Holidays
- Medical Plan options along with participation in a Health Spending Account or a Health Saving account
- Dental, Vision, Life& AD&D Insurance along with Short-term disability and Long-Term Disability coverage
- 401(k) Savings Plan, Employee Stock Purchase Plan
- Education Reimbursement
- Employee Discounts
- Employee Assistance Program
- Employee Referral Bonus Program
- Voluntary Benefits (pet insurance, legal insurance, LTC Insurance, etc.)
- More information can be downloaded at:
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:
- High School Diploma/GED (or higher)
- Licensure Requirement: Active National or State Board Pharmacy Technician Licensure
- Pharmacy Technicians Certification Board (PTCB)
- State Board of Pharmacy Licensure in state of residence
- ExCPT - Pharmacy Technician Certification with National Healthcareer Association (NHA)
- The National Board of Prior Authorization Specialist
- 1+ years of operations experience
- 1+ years of former Customer Relations experience
- Basic proficiency with Microsoft Excel (ability to create, edit, and save a basic spreadsheet), Microsoft Word (ability to create, edit, and save a basic document), and Microsoft Outlook (ability to send emails)
- Able to work 8am to 6pm EST with ability to work flexible hours, including OT and on-call weekends every 5 weeks
Preferred Qualifications:
- Knowledge of Call Center systems such as CMS, IEX, CTI and TCS
Soft Skills:
- Strong communication skills, both written and oral
- Ability to follow through on tasks
- Physical Requirements and Work Environment:
- Frequent speaking, listening using a headset, sitting, use of hands/fingers across keyboard or mouse, handling other objects, long periods working at a computer
- Ability to have their own home internet access (internet can be hard wired with ethernet cord)
- Have a secure workspace/office in their home
- Have level skill with working with PC (ex. using mouse and keyboard, accessing, and navigating through multiple systems and screens)
*All Telecommuters will be required to adhere to UnitedHealth Group's Telecommuter Policy.
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.
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.
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