PBM Operations Analyst - Benefit Configurations
6 days ago
Description
• Configures benefits into the claim adjudication platform, including benefit inclusions/exclusions copay, accumulator, and other benefit parameters. • Prepare for and lead client meetings to discuss benefit plans, gather requirements, and obtain necessary approvals for implementation. • Communicate with clients regarding benefit design, formulary options, and administrative procedures to ensure a clear understanding of offerings. • Develops and executes on test scenarios to ensure accuracy of benefit setup both at initial setup and conducts ongoing monitoring and regression testing. • Works to correct all identified defects. • Performs research and troubleshoots inquiries or issues related to claims adjudication, accumulators, and eligibility. • Ensures all documentation regarding setup and internal controls is always up to date.
Requirements
• Bachelor’s degree preferred. Relevant experience considered for exceptional candidates. • Pharmacy Technician or related experience highly desirable • Familiarity with pharmacy benefit configuration, claims systems, and data analysis • Excellent client-facing skills and the ability to communicate complex information clearly and effectively. • Strong attention to detail and a proactive approach to problem-solving. • Ability to manage multiple projects and prioritize tasks in a fast-paced environment. • 1-3 years of PBM experience in claims or benefit configuration
Benefits
• Health insurance benefits • Flexible working hours • Career development opportunities
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