Prescription Plan Design & Escalations Analyst

Job Description

• Key technologies : admin skills, Microsoft Suite, skills to learn proprietary, office setting skills
• PERFORMS JOB FUNCTIONS UNDER CLOSE SUPERVISION OR PEER REVIEW
• Analyze PBM prescription claim and other applicable systems for medication benefit quality and accuracy
• Support internal and external customers with information on benefits applicable to medication claims
• Perform, evaluate, and assist in defining and improving the quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines.
• Administer, interpret, and maintain current working knowledge of required BCBSAZ systems, procedures, forms and manuals
• Communicate recommendations in regard to medication claim processing and benefit decisions.
• Monitor and investigate reported plan set up system issues
• Participates in quality initiatives; including functions that support audits, reporting, evaluation of quality opportunities and concerns, and creation and implementation of corrective actions as requested.
• Resolve escalated member issues
• Research & provide recommendations for accumulations issues
• Logs all benefit setup issues on error tracking reports

Ideal Candidate Profile Experience :

Highly preferred : 3-4 years of experience with Rx claims or PBM (Pharmacy Benefit Management)

Background in medical claims or related field

Technical Skills :

Strong Excel or Excel-like tool proficiency

VLOOKUPs

Filtering and updating spreadsheets

Using basic formulas in spreadsheets

Comfortable handling large datasets quickly and accurately

Nice to Have :

Data entry experience with an analytical mindset

Experience in Rx claim / PBM work

IMPACT Technology Recruiting provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.

This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.