Sr. Technical Consultant, PBM New Client Implementations

1 month ago

Eden Prairie, United States Optum Full time

As new pharmacy clients are welcomed to OptumRx, the new client implementation team offers a best-in-class onboarding experience that is powered by strong governance and project management. 

The Sr. Business Analyst will work alongside the client implementation team to oversee all aspects of incoming files for new clients, including defining requirements, receive, prepare and load files.  Communicate file loads/progress status to clients.  This role will actively engage with clients, the client implementation team, and operations teams across the OptumRx organization to deliver on our promise. The Sr. Business Analyst will also serve as a Subject Matter Expert and mentor to peers.  

You’ll enjoy the flexibility to telecommute* from anywhere within the U.S. as you take on some tough challenges. 

Primary Responsibilities:  
Leading Myself

  • Seeks out and actively participates in business initiatives that contribute to service excellence, with minimal leadership guidance
  • Understands data standards and identifies data abnormalities. Instills data quality in all outputs that are delivered
  • Recommends and implements improvements to existing processes and assists with adoption of new software tools
  • Thrives in a fast-paced environment
  • 0-10% travel

Relating to People

  • External client facing role. Ownership and responsibility for new client data file requests inclusive of Claims History, Historical Prior Authorization, Disruption Analysis and Lettering, and Continuation of Therapy.
  • Works with internal stakeholders and external clients/vendors to ensure data file requirements scheduling, data file intake, client data management, and quality of data based on requirements
  • Acts as a technical business liaison to communicate complicated technical information to non-technical audiences (both internal and external) effectively

Growing and Developing

  • Writes and maintains detailed documentation including specifications, expected outcomes, validation methodology/processes, test results, recommendations, version control, and configuration design related to external data file requirements
  • Sought out as a subject matter expert.
  • Mentor and lead other team members, providing guidance throughout the implementation process.
  • Keeps current with industries best practices and seeks additional training/seminars to improve technical skills
  • Promotes continuous improvement by ensuring adherence to quality principles and presenting solutions for process excellence. Solves complex problems. Develops innovative approaches.

Getting Work Done

  • Takes ownership and accountability for pre-determined Service Level Agreements by following up and following through on all deliverables
  • Provides consistent and thorough updates. Identifies risks and escalates appropriately
  • Ability to handle and organize a large volume of complex client implementations
  • Leads complex data mapping exercises and data file requirement gathering sessions with external clients and vendors. May lead functional or segment projects.
  • Performs ad-hoc data analysis and reporting as required by implementation needs and prepares data for downstream use


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.

Qualifications - External

Required Qualifications:

  • Undergraduate degree or equivalent experience
  • 3+ years relevant hands-on experience in analytics, business intelligence or comparable data engineering role, including data warehousing, and business intelligence tools, techniques and technology
  • 2+ years of experience with pharmacy claims data, insurance data, managed health care industry and PBM operations
  • 2+ years of experience in an external client facing role
  • Ability to write test cases for QA

  • Full COVID-19 vaccination is an essential job function of this role. Candidates located in states that mandate COVID-19 booster doses must also comply with those state requirements. UnitedHealth Group will adhere to all federal, state and local regulations as well as all client requirements and will obtain necessary proof of vaccination, and boosters when applicable, prior to employment to ensure compliance. Candidates must be able to perform all essential job functions with or without reasonable accommodation

Preferred Qualifications:

  • Experience with implementation and/or managing pharmacy benefits
  • RxClaim experience
  • Working knowledge of standard business applications, Microsoft Office Suite (MS Access, MS Visio, MS Project, MS Word) 
  • Solid knowledge of SQL (complex joins, nested subqueries, aggregation, partitions, functions, pivots and unions) 
  • Solid knowledge of the US healthcare system and healthcare claims data
  • Solid understanding of databases, their architectures and database constraints
  • Ability to execute and deliver within the confines and timeframes provided by regulatory agencies
  • Advanced proficiency with Excel (Pivot tables, pivot charts, conditional formatting, VLOOKUP, formulas)

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