• Act as a subject matter expert on complex pharmacy issues • Respond to escalated calls from members, provider/physician's offices, and pharmacies • Make outbound calls and enter pharmacy overrides into systems • Take member/prescriber/pharmacist inquiry calls for benefit questions • Offer options including submission of prior authorization requests • Research issues and take appropriate action to resolve them • Conduct inbound and outbound calls for claims resolution • Assist team members in guiding them to appropriate resolution of inquiries • Participate in training less experienced staff • Act as a liaison between internal departments for data gathering and problem solving • Present proposed solutions clearly • Assist with audit preparation and special project work as assigned • Comply with all policies and standards

• Manage real time insurance claims while providing customer service to clients • Analyze and approve claims that need to be adjudicated • Determine coverage and apply medical necessity guidelines • Identify and clarify any discrepancies to complete the adjudication process • Work in cohesion with the CIC Department, Prior Authorization, and Billing Departments • Submit claims and add appropriate corrections • Ensure accurate and timely processing of real time claims • Work directly with third party payers for claim resolution • Communicate with facilities on claim issues that will need attention by the facility • Resolve any discrepancies and secure proper reimbursement • Any other duties associated with adjudication • Create Prior Authorizations and notify Authorization team • Follow federal and state regulations • Adhere to company policies and procedures • Follow HIPPA guidelines and regulations

Requisition Number: 2349505 Explore opportunities with CPS, part of the Optum family of businesses. We're dedicated to crafting and delivering innovative hospital and pharmacy solutions for better patient outcomes across the entire continuum of care. With CPS-Optum, you'll work alongside our team of more than 2,500 pharmacy professionals, technology experts, and industry leaders to drive superior financial, clinical, and operational performance for health systems nationwide. Ready to help shape the future of pharmacy and hospital solutions? Join us and discover the meaning behind Caring. Connecting. Growing together. CPS Solutions-OptumRx is seeking a highly motivated pharmacy liaison (full time, non-exempt) who wants to elevate their practice and be a part of an integrated care team. You will be a part of CPS' Advance Team - our frontline responsible for helping implement customers' specialty pharmacy programs. The Advance Team is expected to prepare new customers for a successful program launch and enable those customers to deliver outstanding clinical and operational results within a short period of time. This Team will help recruit and train the permanent staff for each customer program, ensure a smooth customer onboarding experience, and engage with hospital leadership and staff on behalf of CPS-Optum. This position works at least 40 hours per week, primarily Monday through Friday, and requires travel away from home location for varying lengths of time up to 75%. Candidates must possess a valid driver's license and meet the requirements of a motor vehicle record (MVR) check. You'll enjoy the flexibility to work remotely * from anywhere within the U.S. as you take on some tough challenges. Primary Responsibilities: - Educating customer's leadership and clinic staff on the CPS-Optum model, to gain their support - Re-designing workflows to help the customer deliver the CPS-Optum experience to patients - Initializing work in CPS-Optum launch clinics and ensuring that the patient/CPS engagement is appropriate and consistent with customer preferences. This includes: - Ensuring that every patient who can benefit from specialty pharmacy services is identified and met in clinic upon arrival - Explaining the benefits of the customer's specialty pharmacy, without impeding patient choice of pharmacy, and achieving patient participation - Successfully enrolling patients into the program - Performing all benefits investigation, prior authorization, and financial assistance work needed to ensure patients have access to the medication they need - Overseeing services provided to enrolled patients - ensuring that everything from order entry to final verification is completed quickly, accurately, and in accordance with patient's needs - Providing direct support to enrolled patients to ensure that they are supported throughout their therapy regimen and achieve their intended outcome - Appropriately triaging any clinical questions to an appropriate clinician (pharmacist, nurse, or provider) - Assisting the site General Manager with recruitment and training of permanent on-site liaisons - Training client staff liaisons to ensure the CPS-Optum model is followed consistently and each liaison is trained in the same way - Demonstrated ability to work effectively in fast-paced, evolving environments with minimal pre-defined processes, while contributing to the development of future operational standards - Demonstrated ability to adapt to customer-specific preferences and workflows while maintaining compliance with CPS-Optum standards 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 or equivalent - Pharmacy Technician license, active and in good standing (in home state) - Valid driver's license Preferred Qualifications: - Certification through the PTCB, active and in good standing - or willing to become certified/licensed - Experience working with physicians, nurses, and other healthcare professionals (preferably in a medical clinic) - Specialty pharmacy experience (preferably in a hospital setting) - Proficiency in standard workplace software (e.g., MS Office), EMR systems (e.g., EPIC, Cerner, or Meditech), and dispensing systems (e.g., QS1, RX30, or Computer Rx) - Knowledge of benefits investigation, prior authorization support, and patient financial assistance work 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 hourly pay for this role will range from $20.38 to $36.44 per hour based on full-time employment. We comply with all minimum wage laws as applicable. 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.

• Ensure continuous coverage for PipelineRx clients and support pharmacists by managing order flow • Triage and manage high‑volume client calls • Provide basic technical support and coordinate with IT for advanced issues • Contact healthcare professionals to gather clinical or demographic information needed • Support workflow during downtime and help secure emergency shift coverage • Submit nightly shift reports