We’re creating opportunities in every corner of the health care marketplace to improve lives while we’re building careers. And that means continuous career growth opportunities for you. While we support you with the latest tools, advanced training and the combined strength of high caliber co-workers, you can continue on following the path of your life’s best work.(sm)
The Vice President, Benefit Operations – Government Programs will have end to end accountability for the timely and accurate execution of all PBM benefit related business processes that are specific to the administration of Medicare, Medicaid and Individual Exchange lines of business. This senior leadership role within the Government Programs organization has broad functional responsibilities, including but not limited to Optum EGWP member enrollment, benefit coordination, claim reprocessing, Medicare PDE management, pharmacy encounter submissions and the oversight of pharmacy benefit administration. The Vice President of Benefit Operations will maintain mechanisms to measure the accuracy and efficiency of all corresponding operational functions, identifying opportunities for improvement, and advocating for meaningful changes that promote effective scale and ongoing durability. This key leader will direct a broad team of operators and subject matter experts, identifying and promoting the implementation of best practices across the operational model, including ways to best leverage technology where possible. The Vice President of Benefit Operations will be a force multiplier, leading by example and promoting innovation through effective collaboration across the organization.
You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges.
- Own the relationship with all operational vendors that are specific to Optum’s suite of Government specific solutions for Medicare, Medicaid and Individual Exchange lines of business
- Accountable for all enrollment related functions associated with the Optum employer group waiver Part D program (EGWP), overseeing the implementation of changes to support new program guidance, and maintaining rigorous transactional oversight mechanisms to validate ongoing compliance to program requirements
- Lead the teams and associated business processes which are responsible for the generation and submission of all required claims related reporting to program regulators, including Medicare prescription drug events (PDE’s) and state pharmacy encounters for Medicaid and Individual Exchange clients
- Continually measure and evaluate business processes that support regulated claims reporting activities, identifying opportunities to improve operational quality, and meeting or exceeding annual program targets for PDE and/or encounter acceptance rates
- Accountable for all pharmacy claims reprocessing efforts across Optum’s Government portfolio, coordinating reprocessing needs with key stakeholders to meet commitments to clients, regulators and program beneficiaries
- Represent the Government Programs team as a participant within ongoing governance and prioritization discussions pertaining to claim system enhancements and future capabilities for Government lines of business
- Maintain support for a pharmacy claim response team that can quickly mobilize to evaluate the impact of new regulations, respond to questions related to claims transactions and support issue resolution across all associated Government lines of business
- Oversee the accurate and timely loading of pharmacy pricing and network files in support of clients’ Medicare Plan Finder representation
- Accountable for operational models to validate appropriate claims adjudication as well as any downstream efforts based on findings
- Lead departmental efforts to evaluate existing processes, systems, and operations to identify opportunities for further efficiency, timeliness and quality by incorporating new technologies
- Consistently maintain end to end documentation for government programs operating functions including critical business requirements, key performance indicators, necessary process controls, critical dependencies, and tactical ownership
- Coordinate with key business stakeholders oversee the development, validation, and presentation of monthly and quarterly benefit operations reviews, inclusive of variance analysis and recommendations for targeted business process improvements
- Champion efforts to drive continuous process improvement across operations, working to improve operational quality, reduce unnecessary costs, and expand capabilities to support future growth
- Develop and present business cases for future investment, inclusive of long-term impacts costs and applicable ROI models
- Developing annual operational business plans to ensure alignment of priorities and associated operating models with evolving business and product strategy
- Develop operating benchmarks through coordination with enterprise partners and via analysis of publicly available/competitive data
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.
- Bachelor’s degree or equivalent experience
- 10+ years of experience working for a healthcare payer and/or PBM
- 5+ years of healthcare benefit operations experience
- 5+ years of experience leading teams
- 3+ years of experience within healthcare government programs (i.e. Medicare, Medicaid or ACA Individual and Family products)
- 3+ years of experience managing/overseeing vendors
- People management experience
- Advanced degree (MBA, MS, PhD)
- Technical proficiency with reporting and analytic tools, such as: Power BI, Tableau, SQL, SAS or comparable tools
- Prior IT experience and/or proficiency in working with large datasets and query language (e.g. SQL)
- Self-starter with proven experience in driving cross-functional teams to deliver exceptional outcomes
- Employs objective, collaborative approach
- Experience in adapting in a dynamic and high-growth environment
- Exceptional written, verbal, critical thinking, organizational, problem solving and presentational skills
To protect the health and safety of our workforce, patients and communities we serve, UnitedHealth Group and its affiliate companies require all employees to disclose COVID-19 vaccination status prior to beginning employment. In addition, some roles and locations require full COVID-19 vaccination, including boosters, as an essential job function. UnitedHealth Group adheres to all federal, state and local COVID-19 vaccination regulations as well as all client COVID-19 vaccination requirements and will obtain the necessary information from candidates prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation. Failure to meet the vaccination requirement may result in rescission of an employment offer or termination of employment
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)
Colorado, Connecticut or Nevada Residents Only: The salary range for Colorado/Connecticut/Nevada residents is $174,600 to $332,200. Pay is based on several factors including but not limited to education, work experience, certifications, etc. In addition to your salary, UnitedHealth Group offers benefits such as, a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements). No matter where or when you begin a career with UnitedHealth Group, you’ll find a far-reaching choice of benefits and incentives.
*All Telecommuters will be required to adhere to UnitedHealth Group’s Telecommuter Policy.
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.