Associate Director, Network Pricing - Drug Pricing & Claims Integrity -Remote

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 inclusion, talented peers, comprehensive benefits and career development opportunities. Come make an impact on the communities we serve as you help us advance health optimization on a global scale. Join us to start Caring. Connecting. Growing together.

Optum Rx, a UnitedHealth Group company, with over 24,000 employees globally, specializes in the delivery, clinical management and affordability of prescription medications and consumer health products. Our goal is to deliver high-quality, integrated services to promote optimal outcomes, superior savings and outstanding client and consumer experiences. We make healthier happen by creating smarter health care connections to help more than 65 million consumers nationwide realize improved care, lower costs, and a better overall experience. This is a place like no other and where you'll do your life's best work.

OptumRx is looking for a curious, adaptable, and self-motivated Associate Director to be part of our Network Pricing team as a leader in Drug Pricing & Claims Integrity. This is an advanced analytics role where you will learn and apply the business fundamentals of drug pricing, claims adjudication platform logic, the underlying data flows, and the tools and systems used in this type of financial analysis. The person in this role will work with and have regular exposure to analysts and projects in our global data science and network pricing teams. The role partners closely with Network Contracting, Pricing, Technology, Compliance, and Operations teams to ensure that contract terms, reimbursement methodologies, and regulatory requirements are correctly translated into adjudication logic and consistently executed at the point of sale.

Position Description:

Supports and validates unit cost management activities through financial and network pricing modeling, analysis, and reporting. This role is responsible for ensuring accurate pharmaceutical drug pricing and claims adjudication across the pharmacy network by validating pricing logic, adjudication configuration, and contractual compliance within the claims platform (RxClaim). The position focuses on identifying, researching, and correcting claims pricing discrepancies, coding or configuration errors, and pharmacy contract misalignment, with specific accountability for Medicare and CMS compliance requirements, including Plan Finder accuracy.

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

For all hires in the Minneapolis or Washington, D.C. area, you will be required to work in the office a minimum of four days per week.

Primary Responsibilities:

• Own end‑to‑end accountability for prescription drug pricing accuracy and claims adjudication outcomes, from pricing strategy and financial modeling through configuration, validation, and ongoing monitoring
• Develop and maintain financial models to support drug pricing strategy, unit cost targets, reimbursement methodologies, and performance analysis
• Set and validate drug pricing parameters to ensure accurate execution of pharmacy contracts, reimbursement logic, and benefit design within the adjudication platform (RxClaim)
• Identify, research, and resolve claims pricing discrepancies, including incorrect reimbursement or misconfiguration of pricing and adjudication logic
• Perform claims research, adjustments, and corrections as appropriate; identify patterns or systemic issues requiring broader remediation
• Interpret pharmacy contracts and ensure contractual terms are accurately translated into adjudication logic, identifying gaps between negotiated terms and live claims behavior
• Ensure adherence to state and federal regulatory requirements, including CMS and Medicare (Plan Finder) pricing and compliance standards, and support remediation of identified issues
• Partner with network, pricing, compliance, analytics, and technology teams to validate assumptions, resolve issues, and deploy accurate, compliant pricing solutions
• Communicate complex pricing, adjudication, and compliance findings clearly to technical and non‑technical stakeholders, including senior leadership
• Establish and maintain repeatable workflows, documentation, and in