Senior Network Pricing Consultant

Optum; Eden Prairie (MN); On-site; USD 60,000 - 107,000; Full time

Job summary

UnitedHealth Group is seeking a Senior Network Pricing Consultant to analyze and re-price pharmacy claims, leveraging SQL-based data analytics to support pricing decisions and RFPs. This role involves collaborating with finance, accounting, and sales to ensure accurate claim processing and compliant pricing models.

Remote-friendly role across the U.S. with opportunities for growth and development in a diverse, inclusive environment, focusing on health equity and data-driven insights.

Qualifications

• 2+ years of analytical experience in financial analysis, PBM healthcare pricing, Network pricing or related discipline.
• 2+ years of experience with SQL Server or other relational database solutions.
• 2+ years of experience in writing Complex SQL/PLSQL queries for data analysis and reconciliation.
• 2+ years of Analytical experience in data analysis.
• Advanced level of proficiency in MS Excel.

Responsibilities

• Analyze and re-price existing client claims data to support client-specific data analytics using SQL server database.
• Prepare competitive external and internal historical claims data for use in the development of RFP response submission activities.
• Use relational database tools to re-price/trial adjudicate pharmacy claims.
• Validate source data and interpret re-price/QA/trial adjudication and summary and detail report results.
• Analyze source historical claims data for anomalies and/or trends in drug utilization patterns and costs.
• Develop and/or analyze and refine existing analytical models and database queries as appropriate.
• Conduct financial and network pricing modeling, analysis, and reporting.
• Work closely with internal teams, including finance, Accounting, and Sales, to ensure accurate and efficient claim processing.
• Keep detailed records of all pricing adjustments and ensure compliance with all relevant regulations and policies.

Skills

SQL

Complex SQL/PLSQL

MS Excel

Data analysis

Pricing analytics

Tools

SQL Server

Job description

Improve the lives of others while Caring. Connecting. Growing together.

Job Description - Senior Network Pricing Consultant (2381374)

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 startCaring. Connecting. Growing together.

Senior Network Pricing Consultant focuses on analyzing and repricing of pharmacy claims to ensure accurate cost management. This role will work on pricing applications and projects related to the manipulation and analysis of data in support of a variety of analytic solutions.

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

Primary Responsibilities:

• Analyze and re-price existing client claims data to support client-specific data analytics using SQL server database
• Prepare competitive external and internal historical claims data for use in the development of RFP response submission activities
• Use relational database tools to re-price/trial adjudicate pharmacy claims
• Validate source data and interpret re-price/QA/trial adjudication and summary and detail report results
• Analyze source historical claims data for anomalies and/or trends in drug utilization patterns and costs
• Develop and/or analyze and refine existing analytical models and database queries as appropriate
• Conduct financial and network pricing modeling, analysis, and reporting
• Work closely with internal teams, including finance, Accounting, and Sales, to ensure accurate and efficient claim processing
• Keep detailed records of all pricing adjustments and ensure compliance with all relevant regulations and policies

Skills and Abilities:

• Ability to analyze complex data and identify trends and discrepancies
• Ensure accuracy in all aspects of claim analysis and pricing adjustments
• Communicate clearly and effectively with team members and stakeholders
• Understanding of PBM processes, regulations, and industry standards
• Strong skills in SQL and relational database tools

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 analytical experience in financial analysis, PBM healthcare pricing, Network pricing or related discipline
• 2+ years of experience with SQL Server or other relational database solutions
• 2+ years of experience in writing Complex SQL/PLSQL queries for data analysis and reconciliation
• 2+ years of Analytical experience in data analysis
• Advanced level of proficiency in MS Excel

Preferred Qualifications:

• Technical writing skills

*All Telecommuters 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 $60,200 to $107,400 annually based on full-time employment. We comply with all minimum wage laws as applicable.

Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records.

Application Deadline: This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

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.

UnitedHealth Group is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or accommodation for any part of the application process, please call 1-866-566-8715 to be connected to Recruitment Services. Recruitment Services hours of operation are 7 a.m. to 7 p.m. CT, Monday through Friday.

UnitedHealth Group is a registered service mark of UnitedHealth Group, Inc. The UnitedHealth Group name with the dimensional logo, as well as the dimensional logo alone, are both service marks for the UnitedHealth Group, Inc.

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.