Optum Claims Manager Jobs (NOW HIRING)

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 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 Operations Manager, Medicaid Account Management will be responsible for account activities such as: MAC management, provider relations, call center escalations, web portal updates, user acceptance testing, coordination with client pharmacy operations staff, standard and custom report development, and data analytics. The position will report to the Associate Director, Medicaid Account Management on the account team.

Position is expected to start in January 2027

If you are located in Columbia, SC, you will have the flexibility to work remotely* as you take on some tough challenges.

Primary Responsibilities:

• Use industry knowledge to add value to the clients' operations and look for up sell opportunities
• Maintain an ongoing knowledge of clients' business; as well as their contract with Optum
• Provide leadership for new client projects / implementations
• Provide regular communication to management on client concerns and feedback
• Communicate with clients via face - to - face meetings, conference calls and written correspondence
• Interfaces with internal Optum departments
• Maintain client business rules and implement them in the Optum systems
• Understands the eligibility and pharmacy claims adjudication process
• Monitor performance guarantees / Service Level Agreements
• Maintain rates such as State MAC, 340b, and other customer State rates
• Conduct periodic reviews with client and recommend new products / services as appropriate
• Contribute to client satisfaction, retention and growth
• Functions in a dedicated on-site service capacity  

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:

• 2 years of experience supporting a State Medicaid account
• Experience using healthcare claims processing systems and reporting tools
• Experience collaborating with cross-functional internal business partners to deliver contract requirements, support special projects, and resolve operational issues
• Demonstrated knowledge of Medicaid systems, benefits administration, reporting and analytics, and call center escalation processes
• Proficiency with Microsoft Office applications, including Word, Excel, PowerPoint, and Outlook
• Proven ability to lead and facilitate meetings in both in-person and virtual environments, including presentations via Microsoft Teams
• Proven track record of driving client satisfaction and client retention
• Ability to work at the client location in Columbia, SC  25%-50% of the time

Preferred Qualifications:

• Certified Pharmacy Technician (CPhT) certification and active pharmacy technician license
• Experience with Optum Rx claims processing platform (RxClaim)
• Experience with Optum Rx reporting and analytics platform (RxTrack)

*All employees working remotely will be required to adhere to UnitedHealth Group's Telecommuter Policy

Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. In addition to your salary, we offer 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 us, you'll find a far-reaching choice of benefits and incentives. The salary for this role will range from $91,700 - $163,700 annually based on full-time employment. We comply with all minimum wage laws as applicable.

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.    

UnitedHealth Group is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.    

UnitedHealth Group is a drug - free workplace. Candidates are required to pass a drug test before beginning employment.