Senior Benefit Plan Configuration Analyst

2 days ago

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Prime Therapeutics

WebsiteLinkedInAll Job Openings

Pharmacy Benefits Management

1001 - 5000

Description

• Designs, analyzes and implements benefit coding change requests with a high degree of accuracy. • Gathers and analyzes client requirements, assesses the benefit impact on current design and claims processing, presents to the stakeholder and/or other internal partners with benefit setup options, and advises on the best solution. • Responsible for managing less standardized plan design concepts, clients and programs from a coding, testing and validation perspective. • Facilitates conversations within the team to define client intent or program setup. • Facilitates and troubleshoots inquiries amongst multiple internal and external teams until resolution and implementation. • Partners with various teams to analyze customer specific requirements and configuration and translate those into technical design specifications and data flow from which programs are developed and coded. • Actively participates in and contributes to daily communications, team meetings and project/issue resolution. • Participates in and leads internal calls with clients to understand the intent of requested benefit changes. • Identifies, analyzes and presents to leadership creative solutions for process improvement activities regarding benefit configuration. • Analyzes new business requirements for benefit design changes to establish the appropriate solution. • Responsible for accurate management of plan benefits coding changes, test execution and validation efforts of plan benefit design requests. • Maintains customer documentation that validates configuration. • Efficiently and effectively distributes tasks, using clear and concise instructions and expectations. • Completes deliverables independently and within an agile team setting. • Coordinates responses to both external and internal audits. • Ensures workflows support compliance and identifies when audit protocols need to be refreshed to more accurately capture day-to-day procedures. • Evaluates audit findings and implements new processes to bring Benefit Configuration into compliance. • Other duties as assigned.

Requirements

• 2+ years of experience in benefit plan configuration/analysis. • Experience with adjudication processes (FirstRx preferred), analyzing benefit plan design and system application. • Advanced working knowledge of Microsoft office products (specifically Word, Access, Excel), including running queries and macros. • Advanced knowledge of interpreting and understanding prescription benefits. • This role requires strong attention to detail, critical thinking and analytical skills • Ability to work within a team and as an individual contributor in a fast-paced, changing environment. • Strong sense of urgency leading to the timely completion of all projects, training and assignments.