Essential Duties And Responsibilities

Review and understand client specifications and benefit design builds through RxPlan and PharmScreens software platforms
Build/Run standard and custom batch claim files for clients in all lines of business and benefit design complexities
Analyze and interpret test claims for processing and adjudication results to ensure configuration accuracy and compliance
Perform benefit compare analysis between PharmScreens and RxPlan
Conduct automated claims testing through RxPlan, analyzing results
Serve as point of contact for other departments troubleshooting plan/benefit configuration related questions through claims testing
Report findings and follow through with resolution resulting from all analytical work, including but not limited to batch testing, benefit compares, automated claims testing, and applicable inquiries
Field questions from various levels of management pertaining to testing results
Document results and follow through resolution within department’s tracking system
Other duties as assigned

Requirements

Bachelor’s degree in health administration, business or related field; proven industry experience may be acceptable in lieu of degree
Demonstrated ability to manage multiple priorities and deadlines
Ability to independently identify, research, analyze, and resolve issues with minimal supervision
Oral and written communication skills with a high degree of professionalism
Ability to work with peers in a team effort
Time management and organizational skills being able to handle multiple priorities in a fast-paced environment
Ability to work extended hours, weekends, and holidays pursuant with industry demands
Proficient in Microsoft Office and industry related software programs

Preferred Qualifications

Medicare Part D knowledge
Minimum 3 years of pharmacy claim analysis experience and/or PBM experience

Work Environment

Includes a typical office environment, with minimal exposure to excessive noise or adverse environmental issues.

Physical Requirements

Ability to sit for prolonged periods of time.

Elixir

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